Provider Demographics
NPI:1548229669
Name:FOREMAN, JAMIE MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MARIE
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7581 9TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6635
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:4135 RICHARD AVENUE
Practice Address - Street 2:STE 102
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-206-7775
Practice Address - Fax:218-206-7776
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009135225100000X
MN7199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist