Provider Demographics
NPI:1700490323
Name:PTAH, JAMELIA D (LMBT)
Entity Type:Individual
Prefix:MRS
First Name:JAMELIA
Middle Name:D
Last Name:PTAH
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:JAMELIA
Other - Middle Name:BARBETTE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMBT
Mailing Address - Street 1:8402 RAMATH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5695
Mailing Address - Country:US
Mailing Address - Phone:843-475-7828
Mailing Address - Fax:
Practice Address - Street 1:8402 RAMATH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5695
Practice Address - Country:US
Practice Address - Phone:843-475-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist