Provider Demographics
NPI:1205904927
Name:CRESSEND, JAMIE GROVE (MPT)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:GROVE
Last Name:CRESSEND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:ELLEN
Other - Last Name:GROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-2720
Mailing Address - Fax:706-787-8176
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-2720
Practice Address - Fax:706-787-8176
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000Medicare UPIN