Provider Demographics
NPI:1487062568
Name:SEATON, JENNIFER M (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:SEATON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:MCNEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8201 ATLEE RD STE D
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1815
Mailing Address - Country:US
Mailing Address - Phone:804-569-1787
Mailing Address - Fax:804-569-9787
Practice Address - Street 1:2040 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238
Practice Address - Country:US
Practice Address - Phone:804-754-0916
Practice Address - Fax:804-754-0919
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherGROUP MEDICARE PTAN
VA1487062568OtherMEDICAID QMB PROVIDER IDENTIFIER
VAQ47511AMedicare PIN