Provider Demographics
NPI:1225643943
Name:JENNINGS, CAILEN
Entity Type:Individual
Prefix:
First Name:CAILEN
Middle Name:
Last Name:JENNINGS
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 1:3543 E MERIDIAN PARK LOOP STE C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7233
Mailing Address - Country:US
Mailing Address - Phone:907-864-0099
Mailing Address - Fax:907-864-0093
Practice Address - Street 1:3543 E MERIDIAN PARK LOOP STE C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7233
Practice Address - Country:US
Practice Address - Phone:907-864-0099
Practice Address - Fax:907-864-0093
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK213688225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist