Provider Demographics
NPI:1124034004
Name:VALLONE, JAMIE A (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:A
Last Name:VALLONE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:A
Other - Last Name:HERBST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:6 CONOR CT
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2550
Mailing Address - Country:US
Mailing Address - Phone:609-709-2581
Mailing Address - Fax:
Practice Address - Street 1:67 HIGBEE AVE
Practice Address - Street 2:SPECTRUM REHABILITATION, LLC
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2323
Practice Address - Country:US
Practice Address - Phone:609-204-4849
Practice Address - Fax:609-653-1258
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01055500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1124034004OtherNATIONAL PROVIDER IDENTIFIER NUMBER
NJ40QA01055500OtherBOARD OF PHYSICAL THERAPY LICENSE NUMBER