Healthcare Provider Details

I. General information

NPI: 1205235181
Provider Name (Legal Business Name): JAMIE MCROBERTS GRIFFIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE MCROBERTS

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 SOUND BEACH AVE
OLD GREENWICH CT
06870
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 203-817-0196
  • Fax:
Mailing address:
  • Phone: 631-580-5200
  • Fax: 631-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number037669
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11902
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: