Basic Information
| Provider Information | |||||||||
| NPI: | 1669532867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARVIS | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PTA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JARVIS-DEAN | ||||||||
| OtherFirstName: | JAMIE | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | PTA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 287 GUINEA HILL RD | ||||||||
| Address2: | |||||||||
| City: | SLATE HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109734317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453559131 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 FLETCHER ST | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109241402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452948806 | ||||||||
| FaxNumber: | 8452948650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 000737-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.