Individual
MR. JAMIE SHANNON SOUTAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
130 EXECUTIVE DR, NEWARK, DE 19702-3349
(302) 292-3454
(302) 292-3464
Mailing address
203 TINSLEY CT, NEWARK, DE 19702-2819
(302) 266-7122
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
J2-0000488
DE
Other
Enumeration date
05/25/2006
Last updated
07/08/2007
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