Provider Demographics
NPI:1902049950
Name:REEVE, JENNY MARIE (PT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:REEVE
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 1:29 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1503
Mailing Address - Country:US
Mailing Address - Phone:860-967-9919
Mailing Address - Fax:
Practice Address - Street 1:693 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2489
Practice Address - Country:US
Practice Address - Phone:860-242-8427
Practice Address - Fax:860-242-4147
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist