Provider Demographics
NPI:1033251301
Name:PHILIP, JAIME (PT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N BROADWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2113
Mailing Address - Country:US
Mailing Address - Phone:516-827-9446
Mailing Address - Fax:516-827-0042
Practice Address - Street 1:400 N BROADWAY
Practice Address - Street 2:SUITE D
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2113
Practice Address - Country:US
Practice Address - Phone:516-827-9446
Practice Address - Fax:516-827-0042
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist