Provider Demographics
NPI:1306215769
Name:RATKA, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:RATKA
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 1:5889 KING HILL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-8965
Mailing Address - Country:US
Mailing Address - Phone:585-749-7280
Mailing Address - Fax:
Practice Address - Street 1:5889 KING HILL DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425
Practice Address - Country:US
Practice Address - Phone:585-749-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer