Provider Demographics
NPI:1881944783
Name:POORMAN, JAMIE MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:POORMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 FRANK SCOTT PKWY W
Mailing Address - Street 2:SUIT 824
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5007
Mailing Address - Country:US
Mailing Address - Phone:618-237-9705
Mailing Address - Fax:618-257-0665
Practice Address - Street 1:2810 FRANK SCOTT PKWY W
Practice Address - Street 2:SUIT 824
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5007
Practice Address - Country:US
Practice Address - Phone:618-237-9705
Practice Address - Fax:618-257-0665
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist