Provider Demographics
NPI:1275804551
Name:MOUNT, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MOUNT
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:P.O. BOX 445
Mailing Address - Street 2:TTC OF HUNTINGTON INC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25709
Mailing Address - Country:US
Mailing Address - Phone:304-696-4110
Mailing Address - Fax:
Practice Address - Street 1:402 THUNDERING HERD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-0001
Practice Address - Country:US
Practice Address - Phone:304-696-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2011-2922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist