Provider Demographics
NPI:1568600682
Name:IRVIN, JENNIFER A (DPT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:A
Last Name:IRVIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4188 CAPITOL HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5826
Mailing Address - Country:US
Mailing Address - Phone:225-284-7677
Mailing Address - Fax:
Practice Address - Street 1:4188 CAPITOL HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5826
Practice Address - Country:US
Practice Address - Phone:225-284-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA063622251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics