Provider Demographics
NPI:1609082692
Name:MALONE, JAMIE CHRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:CHRISTINE
Last Name:MALONE
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 1:14376 JAMESTOWN BAY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1740
Mailing Address - Country:US
Mailing Address - Phone:636-928-7065
Mailing Address - Fax:
Practice Address - Street 1:107 PIPER HILL DR
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1651
Practice Address - Country:US
Practice Address - Phone:636-928-7065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005023987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist