Provider Demographics
NPI:1114511870
Name:MACKEY, JALEESA IMEARA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JALEESA
Middle Name:IMEARA
Last Name:MACKEY
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 1:360 DEAUVILLE DR APT 10
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2913
Mailing Address - Country:US
Mailing Address - Phone:707-330-0768
Mailing Address - Fax:
Practice Address - Street 1:900 ELICKER RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-1098
Practice Address - Country:US
Practice Address - Phone:412-795-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty