Provider Demographics
NPI:1689703647
Name:MAPHIS, JENNIFER S (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:MAPHIS
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 1:3334 CAPITAL MEDICAL BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4470
Mailing Address - Country:US
Mailing Address - Phone:850-877-8174
Mailing Address - Fax:844-261-6839
Practice Address - Street 1:3334 CAPITAL MEDICAL BLVD STE 400
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4470
Practice Address - Country:US
Practice Address - Phone:850-877-8174
Practice Address - Fax:844-261-6839
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889935500Medicaid