Provider Demographics
NPI:1598172561
Name:JUSCHITSCH, JAIMIE
Entity Type:Individual
Prefix:MS
First Name:JAIMIE
Middle Name:
Last Name:JUSCHITSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7273
Mailing Address - Country:US
Mailing Address - Phone:570-807-5101
Mailing Address - Fax:
Practice Address - Street 1:125 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7273
Practice Address - Country:US
Practice Address - Phone:570-807-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer