Provider Demographics
NPI:1578612636
Name:JAGGER, JUNE P (PT)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:P
Last Name:JAGGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 LABOUNTY DR STE 7
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9403
Mailing Address - Country:US
Mailing Address - Phone:360-380-7336
Mailing Address - Fax:360-380-7310
Practice Address - Street 1:1740 LABOUNTY DR STE 7
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9403
Practice Address - Country:US
Practice Address - Phone:360-380-7336
Practice Address - Fax:360-380-7310
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00001021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335267Medicaid
WAGAB07443Medicare PIN
WA8335267Medicaid