Provider Demographics
NPI:1518160142
Name:PILEGGI, JAMIE W (PTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:W
Last Name:PILEGGI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S STILLMAN ST
Mailing Address - Street 2:UNIT 117
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-8038
Mailing Address - Country:US
Mailing Address - Phone:850-505-4089
Mailing Address - Fax:
Practice Address - Street 1:201 S STILLMAN ST
Practice Address - Street 2:UNIT 117
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-8038
Practice Address - Country:US
Practice Address - Phone:850-505-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA12807225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant