Provider Demographics
NPI:1629356605
Name:STORMS, JIMMIE ROBERT (DPT)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:ROBERT
Last Name:STORMS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 LAKEWOOD HILLS CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46017-9305
Mailing Address - Country:US
Mailing Address - Phone:417-576-7311
Mailing Address - Fax:
Practice Address - Street 1:1904 N CROSS LAKES CIR
Practice Address - Street 2:APT H
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-4978
Practice Address - Country:US
Practice Address - Phone:417-576-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010613A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist