Provider Demographics
NPI:1124199260
Name:HYDE, JENNIFER M (MSPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:HYDE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10328 BERKELEY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-5132
Mailing Address - Country:US
Mailing Address - Phone:804-550-0971
Mailing Address - Fax:
Practice Address - Street 1:9097 ATLEE STATION RD
Practice Address - Street 2:SUITE 303
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2525
Practice Address - Country:US
Practice Address - Phone:804-559-3390
Practice Address - Fax:804-559-3514
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496628Medicare ID - Type Unspecified