Provider Demographics
NPI:1033621248
Name:STANLEY, JAMIE (PTA, BS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PTA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 REAGANS RESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3008
Mailing Address - Country:US
Mailing Address - Phone:218-330-4933
Mailing Address - Fax:
Practice Address - Street 1:1603 S HIAWASSEE RD STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6437
Practice Address - Country:US
Practice Address - Phone:407-532-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27756225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty