Provider Demographics
NPI:1811142904
Name:WEST, JEREL LEE JR (PT)
Entity type:Individual
Prefix:
First Name:JEREL
Middle Name:LEE
Last Name:WEST
Suffix:JR
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 1:329 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4635
Mailing Address - Country:US
Mailing Address - Phone:601-442-3240
Mailing Address - Fax:
Practice Address - Street 1:329 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4635
Practice Address - Country:US
Practice Address - Phone:601-442-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0208225100000X
LA00081R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist