Provider Demographics
NPI:1568891455
Name:CAMERON, JACLYN ROSE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:ROSE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 ROUTE 94
Mailing Address - Street 2:
Mailing Address - City:SALISBURY MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12577-5426
Mailing Address - Country:US
Mailing Address - Phone:845-497-1099
Mailing Address - Fax:
Practice Address - Street 1:2130 ROUTE 94
Practice Address - Street 2:
Practice Address - City:SALISBURY MILLS
Practice Address - State:NY
Practice Address - Zip Code:12577-5426
Practice Address - Country:US
Practice Address - Phone:845-497-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035377-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist