Provider Demographics
NPI:1124120282
Name:MURRAY, JENNIE (PT)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-1002
Mailing Address - Country:US
Mailing Address - Phone:415-847-2372
Mailing Address - Fax:
Practice Address - Street 1:616 N BROOME STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:704-243-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29856225100000X
NCP21592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist