Provider Demographics
NPI:1568901080
Name:JAMIR, NELSON
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:JAMIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S MOUNTAIN VIEW RD APT 102
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3283
Mailing Address - Country:US
Mailing Address - Phone:308-214-0877
Mailing Address - Fax:
Practice Address - Street 1:640 N EISENHOWER ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9588
Practice Address - Country:US
Practice Address - Phone:208-882-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1565225200000X
ID5400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant