Provider Demographics
NPI:1720201445
Name:ST GEORGE, JEAN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:ST GEORGE
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 1:75 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635
Mailing Address - Country:US
Mailing Address - Phone:508-420-3715
Mailing Address - Fax:508-495-7603
Practice Address - Street 1:100 TER HEUN DR
Practice Address - Street 2:FALMOUTH HOSPITAL REHABILITATION SERVICES
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-420-3715
Practice Address - Fax:
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
MA10942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist