Provider Demographics
NPI:1528364221
Name:JAMIE'S PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:JAMIE'S PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:724-788-1770
Mailing Address - Street 1:2284 BROADHEAD ROAD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4685
Mailing Address - Country:US
Mailing Address - Phone:724-788-1770
Mailing Address - Fax:724-788-1994
Practice Address - Street 1:2284 BROADHEAD ROAD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4685
Practice Address - Country:US
Practice Address - Phone:724-788-1770
Practice Address - Fax:724-788-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010361L225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty