Provider Demographics
NPI:1780466227
Name:VENTRESS, JEROME JR (PT)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:VENTRESS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JEROME
Other - Middle Name:
Other - Last Name:VENTRESS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:744 N ALLYSON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4602
Mailing Address - Country:US
Mailing Address - Phone:225-205-1548
Mailing Address - Fax:
Practice Address - Street 1:1555 COTTONDALE DR STE 8
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4162
Practice Address - Country:US
Practice Address - Phone:225-205-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty