Healthcare Provider Details

I. General information

NPI: 1841899325
Provider Name (Legal Business Name): JAMIE L FLYNN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 CHANCELLOR DR
CRESTVIEW HILLS KY
41017-3418
US

IV. Provider business mailing address

7567 CENTRAL PARKE BLVD STE A
MASON OH
45040-6855
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-2233
  • Fax: 859-331-2266
Mailing address:
  • Phone: 513-701-6100
  • Fax: 513-701-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT018717
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-008186
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: