Provider Demographics
NPI:1114371259
Name:MAHER, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17233 N HOLMES BLVD STE 1650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2030
Mailing Address - Country:US
Mailing Address - Phone:602-547-1836
Mailing Address - Fax:602-547-2806
Practice Address - Street 1:17233 N HOLMES BLVD STE 1650
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2030
Practice Address - Country:US
Practice Address - Phone:602-547-1836
Practice Address - Fax:602-547-2806
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist