MEDICARE: MRS. MONIQUE SUZETTE JAMERSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2000167302	MO

General Provider Information

NPI Number	:	1891832044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONIQUE SUZETTE JAMERSON PT

Provider Business Mailing Address
First Line	:	5818 PEBBLE CREEK DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-8325
Country	:	US
Telephone Number	:	573-821-5497
Fax Number	:

Provider Business Practice Location Address
First Line	:	5818 PEBBLE CREEK DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-8325
Country	:	US
Telephone Number	:	573-821-5497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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