Healthcare Provider Details

I. General information

NPI: 1528345428
Provider Name (Legal Business Name): JAMIE FLATT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LAURA SUE HUMPHRESS DR
CAMPBELLSVILLE KY
42718-8899
US

IV. Provider business mailing address

105 LAURA SUE HUMPHRESS DR
CAMPBELLSVILLE KY
42718-8899
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-7768
  • Fax: 270-465-0068
Mailing address:
  • Phone: 270-465-7768
  • Fax: 270-465-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02769
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: