Provider Demographics
NPI:1205262615
Name:GIBBONS, JENNIFER BOOKER (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BOOKER
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:G
Other - Last Name:BOOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:1115 BOULDERS PKWY
Practice Address - Street 2:SUITE 100A
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-4067
Practice Address - Country:US
Practice Address - Phone:804-330-8165
Practice Address - Fax:804-330-5829
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist