Provider Demographics
NPI:1548507718
Name:O'FALLON, JAMIE (DPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:O'FALLON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32040 CAMINO HERENCIA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3837
Mailing Address - Country:US
Mailing Address - Phone:858-382-4842
Mailing Address - Fax:
Practice Address - Street 1:40980 COUNTY CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6002
Practice Address - Country:US
Practice Address - Phone:951-296-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 39501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist