Provider Demographics
NPI:1295958965
Name:LACHANCE, JAMIE M (LMT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:LACHANCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4720 SE 15TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9654
Mailing Address - Country:US
Mailing Address - Phone:239-945-0220
Mailing Address - Fax:239-945-4005
Practice Address - Street 1:4720 SE 15TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9654
Practice Address - Country:US
Practice Address - Phone:239-945-0220
Practice Address - Fax:239-945-4005
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA27009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist