Healthcare Provider Details

I. General information

NPI: 1750934980
Provider Name (Legal Business Name): JAMIE JAWORSKI LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MONTGOMERY AVE
BRYN MAWR PA
19010-1631
US

IV. Provider business mailing address

1417 DEER MEADOW LN
GARNET VALLEY PA
19060-1925
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberRT006869
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: