Provider Demographics
NPI:1811953144
Name:MCMURTREY, JAMIE S (MPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:MCMURTREY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:S
Other - Last Name:PARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:5622 SHERIDAN LAKE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8881
Mailing Address - Country:US
Mailing Address - Phone:307-773-8533
Mailing Address - Fax:307-635-7578
Practice Address - Street 1:1951 BLUEGRASS CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7355
Practice Address - Country:US
Practice Address - Phone:307-773-8533
Practice Address - Fax:307-635-7578
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYBC/BSOther313961
WYRAILROAD MEDICAREOtherP00271401
WY114566500Medicaid
WY114566500Medicaid
WYW20602Medicare PIN