Provider Demographics
NPI:1447576640
Name:PRINS, JAIMIE L (LMT)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:L
Last Name:PRINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MEADOWBROOK RD APT 2
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-5849
Mailing Address - Country:US
Mailing Address - Phone:518-955-8160
Mailing Address - Fax:
Practice Address - Street 1:24 HAMILTON ST STE 4
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4291
Practice Address - Country:US
Practice Address - Phone:518-955-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018903-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist