Provider Demographics
NPI:1134333594
Name:FESMIRE, JENNIFER DAWN (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:FESMIRE
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 1:1780 LAND ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:STALEY
Mailing Address - State:NC
Mailing Address - Zip Code:27355-8190
Mailing Address - Country:US
Mailing Address - Phone:336-622-7398
Mailing Address - Fax:
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:336-832-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist