Provider Demographics
NPI:1376552125
Name:ST. JEAN, JAMES MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:ST. JEAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SCHOOLHOUSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:ME
Mailing Address - Zip Code:04253-3009
Mailing Address - Country:US
Mailing Address - Phone:207-897-4134
Mailing Address - Fax:
Practice Address - Street 1:152 MAIN ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-1507
Practice Address - Country:US
Practice Address - Phone:207-897-3102
Practice Address - Fax:207-897-4387
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM22455OtherHEALTHSOURCE
ME030481OtherBLUE CROSS
ME2233800OtherAETNA
ME01-508758001OtherBLUE CROSS 3- DIGIT
ME0118779OtherCIGNA
ME64-04205OtherUNITED HEALTHCARE
MEMN2353OtherHARVARD PILGRIM
ME2233800OtherAETNA