Provider Demographics
NPI:1780282327
Name:JOSE, JAIME S JR
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:S
Last Name:JOSE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 BLUFFSTONE CV STE A201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LUTHERAN LIVING SENIOR CAMPUS
Practice Address - Street 2:2421 LUTHERAN DRIVE
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761
Practice Address - Country:US
Practice Address - Phone:563-263-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist