Provider Demographics
NPI:1194926949
Name:MINER, JAMIE (PT)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 NETHERLANDS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9655
Mailing Address - Country:US
Mailing Address - Phone:678-521-1620
Mailing Address - Fax:
Practice Address - Street 1:1459 MONTREAL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6900
Practice Address - Country:US
Practice Address - Phone:770-491-2622
Practice Address - Fax:678-990-5847
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12914225100000X
GAPT002746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ20520Medicare UPIN
GA65BBCWBMedicare PIN