Provider Demographics
NPI:1750479440
Name:JAYNES, AMIE PAK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:PAK
Last Name:JAYNES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:277 S CORONA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2425
Mailing Address - Country:US
Mailing Address - Phone:303-946-9484
Mailing Address - Fax:
Practice Address - Street 1:277 S CORONA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:303-946-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist