Provider Demographics
NPI:1134513716
Name:POORMAN, JENNA (DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:POORMAN
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 1:10560 LIGON MILL RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6090
Mailing Address - Country:US
Mailing Address - Phone:919-556-4678
Mailing Address - Fax:919-556-4619
Practice Address - Street 1:10560 LIGON MILL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6090
Practice Address - Country:US
Practice Address - Phone:919-556-4678
Practice Address - Fax:919-556-4619
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist