Basic Information
| Provider Information | |||||||||
| NPI: | 1487062568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEATON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCNEAL | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | L. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8201 ATLEE RD STE D | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231161815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045691787 | ||||||||
| FaxNumber: | 8045699787 | ||||||||
| Practice Location | |||||||||
| Address1: | 2040 JOHN ROLFE PKWY | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047540916 | ||||||||
| FaxNumber: | 8047540919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2014 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305208914 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | C05954 | 01 | VA | GROUP MEDICARE PTAN | OTHER | 1487062568 | 01 | VA | MEDICAID QMB PROVIDER IDENTIFIER | OTHER |