Provider Demographics
NPI:1740883651
Name:FRIERSON, JOCELYN (PT)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:FRIERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3481
Mailing Address - Country:US
Mailing Address - Phone:228-832-8327
Mailing Address - Fax:228-832-8328
Practice Address - Street 1:11010 DAVID ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3481
Practice Address - Country:US
Practice Address - Phone:228-832-8327
Practice Address - Fax:228-832-8328
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist