Provider Demographics
NPI:1215069463
Name:OVERLAND, JAMIE (PT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:OVERLAND
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 1:1500 14TH ST W
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4076
Mailing Address - Country:US
Mailing Address - Phone:701-572-1848
Mailing Address - Fax:701-572-2476
Practice Address - Street 1:1500 14TH ST W
Practice Address - Street 2:SUITE 350
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4076
Practice Address - Country:US
Practice Address - Phone:701-572-1848
Practice Address - Fax:701-572-2476
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist