Provider Demographics
NPI:1033629043
Name:STUBBS, JAMIE NOAH I (LMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NOAH
Last Name:STUBBS
Suffix:I
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2249
Mailing Address - Country:US
Mailing Address - Phone:352-373-2116
Mailing Address - Fax:
Practice Address - Street 1:4041 NW 37TH PL STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6112
Practice Address - Country:US
Practice Address - Phone:352-328-5642
Practice Address - Fax:352-225-3251
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA87798225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist