Basic Information
| Provider Information | |||||||||
| NPI: | 1124199260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HYDE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10328 BERKELEY MANOR DR | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231165132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045500971 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9097 ATLEE STATION RD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231162525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045593390 | ||||||||
| FaxNumber: | 8045593514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2305202826 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.