Provider Demographics
NPI:1164838496
Name:MANSELL, JAMIE LEE (PHD, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:MANSELL
Suffix:
Gender:F
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N BROAD ST
Mailing Address - Street 2:PEARSON HALL 261, DEPT OF KINESIOLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-3302
Mailing Address - Country:US
Mailing Address - Phone:215-204-2153
Mailing Address - Fax:215-204-4414
Practice Address - Street 1:1800 N BROAD ST
Practice Address - Street 2:PEARSON HALL 261, DEPT OF KINESIOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-3302
Practice Address - Country:US
Practice Address - Phone:215-204-2153
Practice Address - Fax:215-204-4414
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PART0032462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer