Provider Demographics
NPI:1508901349
Name:LAVIS, JAMIE LYNNE (ATC, PES, EMT)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:LYNNE
Last Name:LAVIS
Suffix:
Gender:F
Credentials:ATC, PES, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1009
Mailing Address - Country:US
Mailing Address - Phone:814-254-4726
Mailing Address - Fax:
Practice Address - Street 1:413 MARKET ST APT 1
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-1774
Practice Address - Country:US
Practice Address - Phone:814-244-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0040982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer