Healthcare Provider Details

I. General information

NPI: 1144889486
Provider Name (Legal Business Name): JAMIE MARIE DEERR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE MARIE WALLACE DPT

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S STATE ROAD 135
GREENWOOD IN
46143-9825
US

IV. Provider business mailing address

4032 WOODSTONE DR
FLOYDS KNOBS IN
47119-9718
US

V. Phone/Fax

Practice location:
  • Phone: 317-535-4075
  • Fax:
Mailing address:
  • Phone: 502-762-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013352A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: