Provider Demographics
NPI:1013944198
Name:GERIS, JAMIE L (MPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:GERIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2839 W KENNEWICK AVE # 550
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2927
Mailing Address - Country:US
Mailing Address - Phone:509-783-8977
Mailing Address - Fax:509-783-6151
Practice Address - Street 1:2839 W KENNEWICK AVE # 550
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2927
Practice Address - Country:US
Practice Address - Phone:509-783-8977
Practice Address - Fax:509-783-6151
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8340649Medicaid
WA169351OtherDEPT OF LABOR & INDUSTRIE
WA8340649Medicaid