Provider Demographics
NPI:1801883095
Name:HILL, MICHAEL JEREMY (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JEREMY
Last Name:HILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 14TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4458
Mailing Address - Country:US
Mailing Address - Phone:601-693-6700
Mailing Address - Fax:601-693-6699
Practice Address - Street 1:1001 14TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4458
Practice Address - Country:US
Practice Address - Phone:601-693-6700
Practice Address - Fax:601-693-6699
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04724745Medicaid