Provider Demographics
NPI:1316282452
Name:WESTBERRY, JENNIFER LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:WESTBERRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:JEN
Other - Middle Name:LYNN
Other - Last Name:WESTBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:479 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:NEVILS
Mailing Address - State:GA
Mailing Address - Zip Code:31321-3020
Mailing Address - Country:US
Mailing Address - Phone:912-704-5067
Mailing Address - Fax:
Practice Address - Street 1:479 LIVE OAK LN
Practice Address - Street 2:
Practice Address - City:NEVILS
Practice Address - State:GA
Practice Address - Zip Code:31321-3020
Practice Address - Country:US
Practice Address - Phone:912-704-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002129225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant