Provider Demographics
NPI:1881378701
Name:HAMPTON, JEFFERY SCOTT JR (DPT)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:SCOTT
Last Name:HAMPTON
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 29TH ST APT F21
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-6210
Mailing Address - Country:US
Mailing Address - Phone:228-209-0509
Mailing Address - Fax:
Practice Address - Street 1:4016 CASSIMER AVE
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2309
Practice Address - Country:US
Practice Address - Phone:228-280-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT-7541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty