Provider Demographics
NPI:1861431553
Name:LAMOND, JAMIE ALEXANDER (PT, MPT, OCS)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ALEXANDER
Last Name:LAMOND
Suffix:
Gender:F
Credentials:PT, MPT, OCS
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MPT, OCS
Mailing Address - Street 1:425 GREEN LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3305
Mailing Address - Country:US
Mailing Address - Phone:215-920-9609
Mailing Address - Fax:215-508-2829
Practice Address - Street 1:425 GREEN LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3305
Practice Address - Country:US
Practice Address - Phone:215-920-9609
Practice Address - Fax:215-508-2829
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-012783-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0701013000OtherPERSONAL CHOICE PROVIDER
PAAL054843Medicare ID - Type UnspecifiedMEDICARE PROVIDER #