Provider Demographics
NPI:1699552026
Name:CULPEPPER, JAMIE HARMON (LMT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:HARMON
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8359 BEACON BLVD STE 517
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3066
Mailing Address - Country:US
Mailing Address - Phone:312-961-4111
Mailing Address - Fax:
Practice Address - Street 1:8359 BEACON BLVD STE 517
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3066
Practice Address - Country:US
Practice Address - Phone:312-961-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL883131264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist