Provider Demographics
NPI:1508447814
Name:BROBST, JENNA ROSE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:BROBST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 NORTHWAY RD APT 2304
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-8914
Mailing Address - Country:US
Mailing Address - Phone:717-254-1734
Mailing Address - Fax:
Practice Address - Street 1:1801 LOYALSOCK DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2829
Practice Address - Country:US
Practice Address - Phone:717-254-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer