Provider Demographics
NPI:1053893875
Name:FRANKUM, JEREMY KYLE (DPT)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:KYLE
Last Name:FRANKUM
Suffix:
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 1:123 CANAL ST STE 203
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4104
Mailing Address - Country:US
Mailing Address - Phone:912-388-1283
Mailing Address - Fax:912-988-1652
Practice Address - Street 1:123 CANAL ST STE 203
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4104
Practice Address - Country:US
Practice Address - Phone:912-388-1283
Practice Address - Fax:912-988-1652
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist