Provider Demographics
NPI:1629204805
Name:BROYLES, JENNIFER J (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:BROYLES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:PAIGE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1403 MILL RACE DRIVE
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-444-0526
Mailing Address - Fax:540-444-0531
Practice Address - Street 1:126 MILL LANE
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA, INC
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-387-4311
Practice Address - Fax:540-389-6212
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist