Provider Demographics
NPI:1649602483
Name:FREEMAN, JENNIFER LANIER (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LANIER
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 EDGEWOOD AVE
Mailing Address - Street 2:SUITE T103
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 EDGEWOOD AVE SE
Practice Address - Street 2:SUITE T103
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1987
Practice Address - Country:US
Practice Address - Phone:404-883-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist