Provider Demographics
NPI:1497904338
Name:JAMESON, THEODORA BARBER (PT)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:BARBER
Last Name:JAMESON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:THEODORA
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2900 MAIN ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4946
Mailing Address - Country:US
Mailing Address - Phone:203-378-0092
Mailing Address - Fax:203-375-4540
Practice Address - Street 1:1931 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3506
Practice Address - Country:US
Practice Address - Phone:203-384-8681
Practice Address - Fax:203-384-0722
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist