Provider Demographics
NPI:1891832044
Name:JAMERSON, MONIQUE SUZETTE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:SUZETTE
Last Name:JAMERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-8325
Mailing Address - Country:US
Mailing Address - Phone:573-821-5497
Mailing Address - Fax:
Practice Address - Street 1:5818 PEBBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-8325
Practice Address - Country:US
Practice Address - Phone:573-821-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000167302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist