Provider Demographics
NPI:1275564627
Name:HOWERTON, JENNIFER COYLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:COYLE
Last Name:HOWERTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 RIDGEFIELD GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-5826
Mailing Address - Country:US
Mailing Address - Phone:804-347-7974
Mailing Address - Fax:804-272-9257
Practice Address - Street 1:9101 MIDLOTHIAN TPKE STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5022
Practice Address - Country:US
Practice Address - Phone:804-272-9192
Practice Address - Fax:804-272-9257
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00157754OtherRAILROAD MEDICARE
VA285094OtherMAMSI
VA460621OtherBLUE CROSS/BLUE SHIELD
VA001531M74Medicare ID - Type Unspecified