Provider Demographics
NPI:1710103791
Name:NAGLE, JAYME LEE (PT)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:LEE
Last Name:NAGLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAYME
Other - Middle Name:LEE
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:51 MDG
Mailing Address - Street 2:UNIT 2060
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96278 2060
Mailing Address - Country:KR
Mailing Address - Phone:0118231-661-8717
Mailing Address - Fax:0118231-661-3625
Practice Address - Street 1:51 MDG
Practice Address - Street 2:UNIT 2060
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278 2060
Practice Address - Country:KR
Practice Address - Phone:0118231-661-8717
Practice Address - Fax:0118231-661-3625
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist