Provider Demographics
NPI:1093066763
Name:GENGLER, JESSICA ANN (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:GENGLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-222-7474
Mailing Address - Fax:515-222-7491
Practice Address - Street 1:1601 NW 114TH ST STE 151
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7046
Practice Address - Country:US
Practice Address - Phone:515-222-7474
Practice Address - Fax:515-222-7491
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10349225100000X
IA004996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist