Jack Douglas

NPI #1508054404 in Monticello, Mississippi

Provider Information

NPI Number: 1508054404
Entity Type: Individual
Name: Jack Douglas
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Enumeration Date: Oct 5, 2007
Last Updated: Apr 7, 2010

Practice Location

Address: 1065 E BROAD ST
City: Monticello
State: Mississippi
ZIP Code: 39654-7703
Phone: (601) 587-7115

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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