Healthcare Provider Details

I. General information

NPI: 1538167341
Provider Name (Legal Business Name): JAMIE LYNN MCDONOUGH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LYNN WOLFE PT

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NAGLE RD UPMC CENTERS FOR REHAB SERVICES
ERIE PA
16510-2189
US

IV. Provider business mailing address

2101 NAGLE RD
ERIE PA
16510-2189
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-7078
  • Fax: 814-899-5484
Mailing address:
  • Phone: 814-877-7078
  • Fax: 814-899-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013867L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: