Basic Information
| Provider Information | |||||||||
| NPI: | 1952410664 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | THOMAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601791 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601791 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1730 KERNERSVILLE MEDICAL PKWY STE 201 | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272847198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369967001 | ||||||||
| FaxNumber: | 3369960832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8704 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8704 | 01 | NC BOARD OF PT EXAMINERS | OTHER | P00669284 | 01 | NC | RAILROAD MEDICARE | OTHER |