Provider Demographics
NPI:1881724177
Name:MAHRE-MURPHY, JACQUELINE ANN (PT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:MAHRE-MURPHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:A
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:11030 56TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5925
Mailing Address - Country:US
Mailing Address - Phone:253-265-3684
Mailing Address - Fax:
Practice Address - Street 1:11030 56TH ST NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5925
Practice Address - Country:US
Practice Address - Phone:253-265-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist