Healthcare Provider Details

I. General information

NPI: 1437220746
Provider Name (Legal Business Name): MARY CHRISTINA JAMISON D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHERRY TREE CT
STERLING VA
20164-2402
US

IV. Provider business mailing address

101 CHERRY TREE CT
STERLING VA
20164-2402
US

V. Phone/Fax

Practice location:
  • Phone: 304-702-0525
  • Fax:
Mailing address:
  • Phone: 304-702-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number002891
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number25239
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: