Provider Demographics
NPI:1477112001
Name:BREDAHL, JAMIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BREDAHL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 CRESCENT ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3170
Mailing Address - Country:US
Mailing Address - Phone:720-224-2249
Mailing Address - Fax:
Practice Address - Street 1:1 CENTRAL PARK S # LEVELA
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1732
Practice Address - Country:US
Practice Address - Phone:646-973-5432
Practice Address - Fax:212-400-4209
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist