Provider Demographics
NPI:1558764274
Name:DEROLLO, JAMIE MARIE (MBA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MARIE
Last Name:DEROLLO
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Gender:F
Credentials:MBA, ATC
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Mailing Address - Street 1:5303 SPAULDING CT
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9463
Mailing Address - Country:US
Mailing Address - Phone:209-954-5181
Mailing Address - Fax:209-954-5696
Practice Address - Street 1:5151 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6304
Practice Address - Country:US
Practice Address - Phone:209-954-5181
Practice Address - Fax:209-954-5696
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer