Provider Demographics
NPI:1083720031
Name:KRENNERICH, JAN S (PT)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:S
Last Name:KRENNERICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10742 N BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5029
Mailing Address - Country:US
Mailing Address - Phone:713-253-2589
Mailing Address - Fax:281-469-3227
Practice Address - Street 1:10742 N BELMONT CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5029
Practice Address - Country:US
Practice Address - Phone:713-253-2589
Practice Address - Fax:281-469-3227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist