Provider Demographics
NPI:1356464184
Name:MARKIEWICZ, JENNIFER L (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:MARKIEWICZ
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:TRIPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:2803 RIVERSIDE DR
Mailing Address - Street 2:3008
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-7820
Mailing Address - Country:US
Mailing Address - Phone:817-652-0542
Mailing Address - Fax:
Practice Address - Street 1:710 OVILLA RD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75167-9644
Practice Address - Country:US
Practice Address - Phone:972-923-8720
Practice Address - Fax:972-923-8790
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT28852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer