Provider Demographics
NPI:1396176210
Name:LUNSFORD, JAMIE LAUREN
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LAUREN
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 BRITTON GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9635
Mailing Address - Country:US
Mailing Address - Phone:828-361-0357
Mailing Address - Fax:
Practice Address - Street 1:4954 BRITTON GARDENS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9635
Practice Address - Country:US
Practice Address - Phone:828-361-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist