Basic Information
| Provider Information | |||||||||
| NPI: | 1922136050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MABREY | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2829 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313242829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127565699 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 512 S MAIN ST STE A | ||||||||
| Address2: | |||||||||
| City: | HINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313134344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123684131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| 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 | PT003996 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.