Provider Demographics
NPI:1093813065
Name:THOMPSON, JAMIE MARIE (PT, MPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:RATCLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:336 BROAD ST STE 2093
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3006
Mailing Address - Country:US
Mailing Address - Phone:386-763-0084
Mailing Address - Fax:386-763-0085
Practice Address - Street 1:401 VENTURE DR STE B
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3475
Practice Address - Country:US
Practice Address - Phone:386-763-0084
Practice Address - Fax:386-763-0085
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist