Provider Demographics
NPI:1235113093
Name:JENNESS, CHRISTOPHER CLAY (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:CLAY
Last Name:JENNESS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 DENIS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4345
Mailing Address - Country:US
Mailing Address - Phone:307-234-9067
Mailing Address - Fax:307-234-9074
Practice Address - Street 1:3831 DENIS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4345
Practice Address - Country:US
Practice Address - Phone:307-234-9067
Practice Address - Fax:307-234-9074
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q33329Medicare UPIN