Jennifer Bambrough, DPT
Individual provider Active NPI Physical Therapist · Chattanooga, TN
NPI 1164024816 · NPPES record last updated Mar 28, 2022
Key facts
- NPI
- 1164024816
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 12211 (TN)
- Practice address
- 404 Lark LN
Chattanooga, TN 37415-1902 - Phone
- (262) 442-2188
- NPI assigned
- Nov 9, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
13 W Kent St
Suite 102
Chattanooga, TN 37405-9913
Phone (262) 442-2188
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211210001522 | TN | Practitioner - Physical Therapist in Private Practice | 8224443247 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12211 | TN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dizzy Physical Therapist LLC | Physical Therapist | Current |
Accepting new patients |
| Ascent Physical Therapy and Performance LLC | Physical Therapist | Current |
Accepting new patients |
Locations
13 W Kent St
Ste 102
Chattanooga, TN 37405
Phone (262) 442-2188
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12211 | TN | Yes |
Addresses
Primary practice location
404 Lark LN
Chattanooga, TN 37415-1902
Mailing address
404 Lark LN
Chattanooga, TN 37415-1902
Phone (262) 442-2188
Other providers in Chattanooga, TN
- Julie Ballou
- Balm in Gilead Care Services, LLC
- Jeffrey Scott Balser
- Robin S Balser
- Joanna Baltazar Uribe
- Patricia Maddox Bandy
- Joan Cate Bang
- Rachel Dion Banks
- Samuel L Banks
- Sarah Banks
All providers in Chattanooga, TN · Physical Therapist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.