Provider Demographics
NPI:1306355490
Name:CLEARY, JENA L (DPT)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:L
Last Name:CLEARY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:L
Other - Last Name:HECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2714 W OXFORD LOOP
Mailing Address - Street 2:STE 164
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5714
Mailing Address - Country:US
Mailing Address - Phone:662-232-8949
Mailing Address - Fax:662-232-8950
Practice Address - Street 1:2714 W OXFORD LOOP STE 164
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5714
Practice Address - Country:US
Practice Address - Phone:662-232-8949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3777225100000X
MSPT6557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist