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General NPI Number Information
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NPI Number | 1245472760
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Entity Type | Individual
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Provider Name | DESTINI CONEY JAMMEH PTA
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Gender | Female
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 414 17TH ST SE
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City | AUBURN
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State | WA
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Zip | 98002-6822
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Country | US
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Telephone | 253-876-7235
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Fax |
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Provider Business Mailing Address
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Address Line | 23309 61ST AVE S APT EE202
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City | KENT
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State | WA
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Zip | 98032-4831
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Country | US
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Telephone | 325-232-0835
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P160029218
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License Number State | WA
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