Provider Demographics
NPI:1164079109
Name:CARGNONI, JAYME LEIGH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:LEIGH
Last Name:CARGNONI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 PIEDMONT AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4792
Mailing Address - Country:US
Mailing Address - Phone:510-547-1630
Mailing Address - Fax:510-923-1944
Practice Address - Street 1:12692 CABEZON PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-3013
Practice Address - Country:US
Practice Address - Phone:858-472-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist