Healthcare Provider Details

I. General information

NPI: 1154972214
Provider Name (Legal Business Name): JAMIE LEE HARGREAVES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHEATFIELD DR STE 1
MILFORD PA
18337-7699
US

IV. Provider business mailing address

PO BOX 840
HARRIS NY
12742-0840
US

V. Phone/Fax

Practice location:
  • Phone: 570-296-5911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE012278
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT033896
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: