Provider Demographics
NPI:1518145358
Name:CREVIER, JAMIE R (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:R
Last Name:CREVIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 7TH ST APT 2220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1590
Mailing Address - Country:US
Mailing Address - Phone:413-636-6035
Mailing Address - Fax:
Practice Address - Street 1:525 W 7TH ST APT 2220
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1590
Practice Address - Country:US
Practice Address - Phone:413-636-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18024225100000X
CT008223225100000X
NC11801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist