Provider Demographics
NPI:1083052898
Name:LADNER, JENNIFER L (ATC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:LADNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 LANTANA BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-5631
Mailing Address - Country:US
Mailing Address - Phone:228-669-0792
Mailing Address - Fax:
Practice Address - Street 1:5132 BEATLINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3869
Practice Address - Country:US
Practice Address - Phone:228-669-0792
Practice Address - Fax:228-575-8891
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT04772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer