Provider Demographics
NPI:1770072027
Name:RAVELLI, JAMIE N (DPT)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:N
Last Name:RAVELLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MELVIN HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-4355
Mailing Address - Country:US
Mailing Address - Phone:207-299-4941
Mailing Address - Fax:
Practice Address - Street 1:279 MELVIN HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-4355
Practice Address - Country:US
Practice Address - Phone:207-299-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3468208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation