Provider Demographics
NPI:1841600533
Name:SCOGGINS, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 ROLLIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-9699
Mailing Address - Country:US
Mailing Address - Phone:512-415-5644
Mailing Address - Fax:
Practice Address - Street 1:391 ROLLIN RD
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257-9699
Practice Address - Country:US
Practice Address - Phone:512-415-5644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT225100000X
NY032104225100000X
MA18893225100000X
VT040.0059243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist