Provider Demographics
NPI:1770706921
Name:MOLENKAMP, JAIME SUE (PTA)
Entity type:Individual
Prefix:MISS
First Name:JAIME
Middle Name:SUE
Last Name:MOLENKAMP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1522 E SOUTHERN AVE
Mailing Address - Street 2:APT 1006
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5689
Mailing Address - Country:US
Mailing Address - Phone:616-460-2133
Mailing Address - Fax:
Practice Address - Street 1:3532 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-4440
Practice Address - Country:US
Practice Address - Phone:602-272-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7639A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant