Healthcare Provider Details

I. General information

NPI: 1689349532
Provider Name (Legal Business Name): JENNA R SILVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N HANCOCK ST
PHILADELPHIA PA
19123-2334
US

IV. Provider business mailing address

226 W RITTENHOUSE SQ APT 1514
PHILADELPHIA PA
19103-5747
US

V. Phone/Fax

Practice location:
  • Phone: 267-978-4305
  • Fax:
Mailing address:
  • Phone: 215-356-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: