Individual
JAMIE M ORANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
19958 FAIRFIELD RD, MT. VERNON, IL 62864
(618) 367-5859
Mailing address
19958 FAIRFIELD RD, MT. VERNON, IL 62864
(618) 367-5859
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.004373
IL
Other
Enumeration date
06/08/2011
Last updated
06/08/2011
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