Provider Demographics
NPI:1164684585
Name:BERRYHILL, JENNY M (PT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:M
Last Name:BERRYHILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:M
Other - Last Name:BOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5909 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3039
Mailing Address - Country:US
Mailing Address - Phone:208-343-7700
Mailing Address - Fax:208-331-2591
Practice Address - Street 1:5909 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-3039
Practice Address - Country:US
Practice Address - Phone:208-343-7700
Practice Address - Fax:208-331-2591
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT2392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist