| Doctor Name: | JACK DOUGLAS |
| NPI Number: | 1508054404 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PT3353 |
| Business Practice Address: | 1065 E Broad St Monticello, MS - 396547703 |
| Business Phone Number: | 6015877115 |
| Business Fax Number: | |
| Mailing Address: | 4109 Highway 98 W, SUMMIT |
| State: | MS |
| Postal Code: | 396669132 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/05/2007 |
| NPI Last Update Date: | 04/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT3353 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |