Healthcare Provider Details

I. General information

NPI: 1033468780
Provider Name (Legal Business Name): JAIMIE DOUGLASS BARRON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

131 DOVE LN
MIDDLETOWN CT
06457-6245
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax:
Mailing address:
  • Phone: 610-762-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: