Provider Demographics
NPI:1700803426
Name:JEANENE M NOVER MPT PLLC
Entity Type:Organization
Organization Name:JEANENE M NOVER MPT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:206-855-0955
Mailing Address - Street 1:840 MADISON AVE N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1769
Mailing Address - Country:US
Mailing Address - Phone:206-855-0955
Mailing Address - Fax:
Practice Address - Street 1:840 MADISON AVE N
Practice Address - Street 2:SUITE 102
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1769
Practice Address - Country:US
Practice Address - Phone:206-855-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8802559Medicare ID - Type UnspecifiedGROUP #