Provider Demographics
NPI:1205624152
Name:MOONEY, JOSEPH JASON (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JASON
Last Name:MOONEY
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 PARRISH RD
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482-4482
Mailing Address - Country:US
Mailing Address - Phone:601-517-0346
Mailing Address - Fax:
Practice Address - Street 1:18 MELODY LN
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-9002
Practice Address - Country:US
Practice Address - Phone:601-765-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist