Provider Demographics
NPI:1447854948
Name:MCALISTER, JAMIE L (PTA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:MCALISTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-1441
Mailing Address - Country:US
Mailing Address - Phone:520-869-6932
Mailing Address - Fax:
Practice Address - Street 1:861 E COOLEY ST STE B
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5121
Practice Address - Country:US
Practice Address - Phone:928-537-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7252A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant