Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Douglas

Individual provider Physical Therapist · NPI 1508054404

Jack Douglas is a Physical Therapist in Monticello, Mississippi. Practices as a sole proprietor. Licensed in Mississippi.

Licensed in
MS
In the registry since
2007
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Practice location Address checks out

1065 E Broad St
Monticello, MS 39654-7703
Phone: (601) 587-7115
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT3353 (MS)

Record details

NPI number1508054404
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 5, 2007
Last updated in NPPESApril 7, 2010

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