Provider Demographics
NPI:1790358083
Name:HARVEY, JENNIFER DELORIS (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DELORIS
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 TRACTION AVE
Mailing Address - Street 2:
Mailing Address - City:MONONGAH
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1132
Mailing Address - Country:US
Mailing Address - Phone:304-838-4073
Mailing Address - Fax:
Practice Address - Street 1:199 COURT ST
Practice Address - Street 2:
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378-8548
Practice Address - Country:US
Practice Address - Phone:304-884-7811
Practice Address - Fax:304-884-7057
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000568225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant