Provider Demographics
NPI:1225217938
Name:KETCHNER, JANE ELIZABETH (LPT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELIZABETH
Last Name:KETCHNER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1008
Mailing Address - Country:US
Mailing Address - Phone:579-675-9588
Mailing Address - Fax:
Practice Address - Street 1:301 LAKE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1008
Practice Address - Country:US
Practice Address - Phone:579-675-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006155L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist