Provider Demographics
NPI:1164777348
Name:JAMERSON, LEAH TARYN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:TARYN
Last Name:JAMERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:1400 JOHNSTON WILLIS DR
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4765
Practice Address - Country:US
Practice Address - Phone:804-379-3840
Practice Address - Fax:804-379-9567
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2013-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA2305207464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist