Provider Demographics
NPI:1871883637
Name:MARKLEY, JENIFER BRESHEARS (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:BRESHEARS
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 LA DAWN LN NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1930
Mailing Address - Country:US
Mailing Address - Phone:404-314-5505
Mailing Address - Fax:
Practice Address - Street 1:2150 LA DAWN LN NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1930
Practice Address - Country:US
Practice Address - Phone:404-314-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist