Individual
JAIMIE MARIE VACHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
09162R
LA
225100000X
Physical Therapist
Primary
CP002604T
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2317687
—
LA
Enumeration date
04/06/2018
Last updated
07/27/2020
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