Provider Demographics
NPI:1164010815
Name:CHUANG, JENNIFER CLARA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLARA
Last Name:CHUANG
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 1:301 E MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3768
Mailing Address - Country:US
Mailing Address - Phone:509-962-7386
Mailing Address - Fax:509-925-8476
Practice Address - Street 1:301 E MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3768
Practice Address - Country:US
Practice Address - Phone:509-962-7386
Practice Address - Fax:509-925-8476
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60971382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist