Provider Demographics
NPI:1750115895
Name:VANDERGRIFT, JENNIFER L (LPTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:VANDERGRIFT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 NOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3921
Mailing Address - Country:US
Mailing Address - Phone:540-598-6259
Mailing Address - Fax:
Practice Address - Street 1:1344 NOVER AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3921
Practice Address - Country:US
Practice Address - Phone:540-598-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant