Provider Demographics
NPI:1528180106
Name:FLYNN, JENIFER A (PT)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:A
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:A
Other - Last Name:JANSZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1100 BLYTHE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5814
Mailing Address - Country:US
Mailing Address - Phone:704-355-8484
Mailing Address - Fax:704-355-4231
Practice Address - Street 1:1100 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5814
Practice Address - Country:US
Practice Address - Phone:704-355-8484
Practice Address - Fax:704-355-4231
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist