Provider Demographics
NPI:1124272588
Name:JENNIFER BRASSFIELD PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:JENNIFER BRASSFIELD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-598-6415
Mailing Address - Street 1:3122 NW CRAFTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8337
Mailing Address - Country:US
Mailing Address - Phone:541-598-6415
Mailing Address - Fax:
Practice Address - Street 1:121 NW GREENWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2079
Practice Address - Country:US
Practice Address - Phone:541-312-4253
Practice Address - Fax:541-330-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy