Provider Demographics
NPI:1003842857
Name:NOVER, JEANENE MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:JEANENE
Middle Name:MARIE
Last Name:NOVER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 MADISON AVE N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1823
Mailing Address - Country:US
Mailing Address - Phone:206-855-0955
Mailing Address - Fax:206-855-0801
Practice Address - Street 1:840 MADISON AVE N
Practice Address - Street 2:SUITE 102
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1769
Practice Address - Country:US
Practice Address - Phone:206-855-0955
Practice Address - Fax:206-855-0801
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8802561Medicare ID - Type Unspecified