Provider Demographics
NPI:1467615468
Name:MEDLIN, JENNIFER MATTHEWS (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MATTHEWS
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BAY ST
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1445
Mailing Address - Country:US
Mailing Address - Phone:803-245-9327
Mailing Address - Fax:
Practice Address - Street 1:119 BAY ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1445
Practice Address - Country:US
Practice Address - Phone:803-245-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist