Provider Demographics
NPI:1871644104
Name:KERSTIENS, JAMIE RAE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:RAE
Last Name:KERSTIENS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 RIDDLE LN
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469-2232
Mailing Address - Country:US
Mailing Address - Phone:931-853-6579
Mailing Address - Fax:
Practice Address - Street 1:2380 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4809
Practice Address - Country:US
Practice Address - Phone:931-762-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA3433225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant