Provider Demographics
NPI:1437629946
Name:AGEMA, JENNIFER FINCH (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FINCH
Last Name:AGEMA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3819
Mailing Address - Country:US
Mailing Address - Phone:843-567-2307
Mailing Address - Fax:
Practice Address - Street 1:1038 MCGILL LN
Practice Address - Street 2:
Practice Address - City:SAINT STEPHEN
Practice Address - State:SC
Practice Address - Zip Code:29479-3196
Practice Address - Country:US
Practice Address - Phone:843-567-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2985225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant