Provider Demographics
NPI:1093872459
Name:PLAISANCE, JENNIFER MATHERNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MATHERNE
Last Name:PLAISANCE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MATHERNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:120 WHITE ROSE DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2644
Practice Address - Country:US
Practice Address - Phone:985-532-9662
Practice Address - Fax:985-532-3942
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3A297C943OtherMEDICARE
LA3A297CU46Medicare PIN
LA1022624Medicaid
766392OtherOPTUM
LA314651YUZ5OtherMEDICARE PTAN
LA314651YWWBOtherMEDICARE PTAN
LAP00422471OtherRAILROAD MEDICARE