Provider Demographics
NPI:1558010181
Name:NARVAEZ, JEANNE ROSE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:ROSE
Last Name:NARVAEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JEANNE
Other - Middle Name:ROSE
Other - Last Name:BARTOLOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:294 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3544
Mailing Address - Country:US
Mailing Address - Phone:850-331-3017
Mailing Address - Fax:
Practice Address - Street 1:294 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3544
Practice Address - Country:US
Practice Address - Phone:850-331-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist