Provider Demographics
NPI:1992953640
Name:BOERSMA, JAMIE ANN (DPT)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ANN
Last Name:BOERSMA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 NE 83 AVE
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32680-6008
Mailing Address - Country:US
Mailing Address - Phone:503-984-1891
Mailing Address - Fax:
Practice Address - Street 1:1315 NW 21ST AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1977
Practice Address - Country:US
Practice Address - Phone:352-493-2999
Practice Address - Fax:352-493-0026
Is Sole Proprietor?:No
Enumeration Date:2008-09-07
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist