Provider Demographics
NPI:1457730764
Name:SACKETT, JAMIE (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SACKETT
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 1:2899 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5803
Mailing Address - Country:US
Mailing Address - Phone:770-978-0005
Mailing Address - Fax:770-978-0405
Practice Address - Street 1:2899 FIVE FORKS TRICKUM RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5803
Practice Address - Country:US
Practice Address - Phone:770-978-0005
Practice Address - Fax:770-978-0405
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist