Provider Demographics
NPI:1912064098
Name:GADDY, JENNIFER LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:GADDY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:FL
Mailing Address - Zip Code:32580-1774
Mailing Address - Country:US
Mailing Address - Phone:254-247-9064
Mailing Address - Fax:833-869-6437
Practice Address - Street 1:424 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:FL
Practice Address - Zip Code:32580-1774
Practice Address - Country:US
Practice Address - Phone:254-247-9064
Practice Address - Fax:833-869-6437
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist