Provider Demographics
NPI:1750937538
Name:COON, JAMIE LATTA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LATTA
Last Name:COON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:CALLAHAN
Other - Last Name:LATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2820 WATERFORD LAKE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3994
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2820 WATERFORD LAKE DR STE 103
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3994
Practice Address - Country:US
Practice Address - Phone:804-249-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist