Provider Demographics
NPI:1033835137
Name:JAMIE OCONNOR PT
Entity Type:Organization
Organization Name:JAMIE OCONNOR PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-397-6805
Mailing Address - Street 1:1231 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3135
Mailing Address - Country:US
Mailing Address - Phone:818-397-6805
Mailing Address - Fax:
Practice Address - Street 1:1231 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3135
Practice Address - Country:US
Practice Address - Phone:818-397-6805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417499583Medicaid
CA292298OtherPHYSICAL THERAPY BOARD OF CALIFORNIA