Provider Demographics
NPI:1013263243
Name:DOUGLASS, JAMIE (DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3624
Mailing Address - Country:US
Mailing Address - Phone:908-839-8572
Mailing Address - Fax:
Practice Address - Street 1:4772 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3354
Practice Address - Country:US
Practice Address - Phone:732-364-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01450200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist