Provider Demographics
NPI:1629582325
Name:JAMIESON, RODERICK A
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:A
Last Name:JAMIESON
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 1:51 GARDNER ST # 2
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2105
Mailing Address - Country:US
Mailing Address - Phone:717-414-2323
Mailing Address - Fax:
Practice Address - Street 1:51 GARDNER ST # 2
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2105
Practice Address - Country:US
Practice Address - Phone:717-414-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer