Provider Demographics
NPI:1316225865
Name:DAY, JENNELL LYN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNELL
Middle Name:LYN
Last Name:DAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNELL
Other - Middle Name:LYN
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:1302 PROSPECT AVE STE C
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3928
Practice Address - Country:US
Practice Address - Phone:406-502-1900
Practice Address - Fax:406-502-1333
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005251225100000X
MT2319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1212Medicare PIN
IAIB1213Medicare PIN
IAIB1213035Medicare PIN
IAIB1212033Medicare PIN