Provider Demographics
NPI:1124358403
Name:PAULLEY, JENNIFER S
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:PAULLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 SUMMIT BLVD APT 172
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4331
Mailing Address - Country:US
Mailing Address - Phone:850-741-6715
Mailing Address - Fax:850-204-0489
Practice Address - Street 1:3964 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1104
Practice Address - Country:US
Practice Address - Phone:850-741-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist