Provider Demographics
NPI:1336530914
Name:STOKES, JAMIE (DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:STOKES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 SUMMERTON DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-8736
Mailing Address - Country:US
Mailing Address - Phone:601-624-5929
Mailing Address - Fax:769-235-6763
Practice Address - Street 1:665 S PEAR ORCHARD RD STE 114
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4859
Practice Address - Country:US
Practice Address - Phone:769-235-6788
Practice Address - Fax:769-235-6763
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0206739Medicaid