Provider Demographics
NPI:1144553983
Name:BROWDER, JENNIFER W (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:BROWDER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:204 GUMWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-6087
Practice Address - Country:US
Practice Address - Phone:757-357-7762
Practice Address - Fax:757-357-7765
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004979796Medicaid
VA1144553983OtherMEDICAID QMB
VAC05954OtherGROUP MEDICARE PIN
VA496633Medicare PIN
VAQ45526AMedicare PIN