Provider Demographics
NPI:1225366693
Name:CHASE, JENNA L (DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:CHASE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:L
Other - Last Name:MANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:345 LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2107
Mailing Address - Country:US
Mailing Address - Phone:610-955-8679
Mailing Address - Fax:
Practice Address - Street 1:345 LEWIS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2107
Practice Address - Country:US
Practice Address - Phone:610-955-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist