Provider Demographics
NPI:1184617730
Name:JERMIER, JAYME R (PT)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:R
Last Name:JERMIER
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:PO BOX 6127
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-0157
Mailing Address - Country:US
Mailing Address - Phone:608-222-2325
Mailing Address - Fax:608-222-3823
Practice Address - Street 1:4100 MONONA DR
Practice Address - Street 2:MONONA REHABILITATION SERVICES INC
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1674
Practice Address - Country:US
Practice Address - Phone:608-222-2325
Practice Address - Fax:608-222-3823
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2804024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23338Medicare UPIN