Provider Demographics
NPI:1932540069
Name:MIMNA, JAMIE ANN (LMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:MIMNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-2141
Mailing Address - Country:US
Mailing Address - Phone:717-676-2006
Mailing Address - Fax:
Practice Address - Street 1:29 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-2141
Practice Address - Country:US
Practice Address - Phone:717-676-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist