Provider Demographics
NPI:1518287903
Name:FUQUA, JAMIE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:FUQUA
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 1:1600 E EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-3847
Mailing Address - Country:US
Mailing Address - Phone:800-365-7402
Mailing Address - Fax:
Practice Address - Street 1:1600 E EUCLID ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-3847
Practice Address - Country:US
Practice Address - Phone:800-365-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist