Provider Demographics
NPI:1184811788
Name:FIELDS, JENNIFER BORING (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BORING
Last Name:FIELDS
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 1:4222 RANGE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2109
Mailing Address - Country:US
Mailing Address - Phone:605-716-4599
Mailing Address - Fax:
Practice Address - Street 1:4222 RANGE VIEW CT
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2109
Practice Address - Country:US
Practice Address - Phone:605-716-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist