Individual
JAIMIE MARIE VACHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1800 BUCKNER ST STE C249, SHREVEPORT, LA 71101-4447
(318) 934-1969
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(531) 389-4223
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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