Provider Demographics
NPI:1164093415
Name:DENNIS JANSOHN, JAMIE MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MICHELLE
Last Name:DENNIS JANSOHN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1230 RODRICK DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3225
Mailing Address - Country:US
Mailing Address - Phone:770-598-9070
Mailing Address - Fax:
Practice Address - Street 1:4580 TOWNE LAKE PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5521
Practice Address - Country:US
Practice Address - Phone:678-771-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist