Provider Demographics
NPI:1164283396
Name:DORREL, JENNIFER (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DORREL
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 1:19273 17TH RD
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:IN
Mailing Address - Zip Code:46511-9690
Mailing Address - Country:US
Mailing Address - Phone:574-339-4723
Mailing Address - Fax:
Practice Address - Street 1:19273 17TH RD
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:IN
Practice Address - Zip Code:46511-9690
Practice Address - Country:US
Practice Address - Phone:574-339-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008249A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist