Provider Demographics
NPI:1760600183
Name:KAMON-BRANCAZIO, JAMIE N (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:N
Last Name:KAMON-BRANCAZIO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-9046
Mailing Address - Country:US
Mailing Address - Phone:928-453-1974
Mailing Address - Fax:
Practice Address - Street 1:1695 MESQUITE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5678
Practice Address - Country:US
Practice Address - Phone:928-680-2639
Practice Address - Fax:928-680-2626
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist