Provider Demographics
NPI:1972564557
Name:CHARLES, JAMI LIN (MPT, ATC)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:LIN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:LIN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3771 PETERS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:PA
Mailing Address - Zip Code:17032-8605
Mailing Address - Country:US
Mailing Address - Phone:717-896-7612
Mailing Address - Fax:717-896-7617
Practice Address - Street 1:3771 PETERS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8605
Practice Address - Country:US
Practice Address - Phone:717-896-7612
Practice Address - Fax:717-896-7617
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101091746 0001Medicaid
PA079134F9GMedicare ID - Type Unspecified
PA101091746 0001Medicaid