Basic Information
| Provider Information | |||||||||
| NPI: | 1346492626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLADE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | SCARBOROUGH | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX V | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302240047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702296498 | ||||||||
| FaxNumber: | 7702296958 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302244214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702296498 | ||||||||
| FaxNumber: | 7702296958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2008 | ||||||||
| LastUpdateDate: | 10/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT007331 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.