Provider Demographics
NPI:1083278709
Name:LONG, JAYME (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 FIELDSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERHILL
Mailing Address - State:PA
Mailing Address - Zip Code:15958-3908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:430 PENN LINCOLN DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-9781
Practice Address - Country:US
Practice Address - Phone:724-695-5661
Practice Address - Fax:724-695-7135
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0003912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer