Provider Demographics
NPI:1124406558
Name:THOMAS, JENECA LEA (DPT)
Entity Type:Individual
Prefix:
First Name:JENECA
Middle Name:LEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENECA
Other - Middle Name:LEA
Other - Last Name:HOIDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17403 43RD DR NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7993
Mailing Address - Country:US
Mailing Address - Phone:425-923-4496
Mailing Address - Fax:
Practice Address - Street 1:402 91ST AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2530
Practice Address - Country:US
Practice Address - Phone:425-261-9827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist