Provider Demographics
NPI:1285860916
Name:AUSTELL, JENNA FRANCINE (PT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:FRANCINE
Last Name:AUSTELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 MCLAUGHLIN RD
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4710
Mailing Address - Country:US
Mailing Address - Phone:719-495-3133
Mailing Address - Fax:719-495-8685
Practice Address - Street 1:3475 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-0005
Practice Address - Country:US
Practice Address - Phone:919-681-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10629225100000X
CO0012765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist