Provider Demographics
NPI:1326450842
Name:HYLAND, JENNIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:HYLAND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 ROSELANE ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7902
Mailing Address - Country:US
Mailing Address - Phone:470-259-5226
Mailing Address - Fax:267-321-2044
Practice Address - Street 1:4701 W PARKER RD
Practice Address - Street 2:SUITE 625
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3376
Practice Address - Country:US
Practice Address - Phone:972-398-2555
Practice Address - Fax:972-398-9003
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3115337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX471309ZS1MMedicare PIN
TX470447Medicare PIN