Provider Demographics
NPI:1326579970
Name:MANSFIELD, JENNY (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:MANSFIELD
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 1:755 EPPS BRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6987
Mailing Address - Country:US
Mailing Address - Phone:706-979-2102
Mailing Address - Fax:
Practice Address - Street 1:755 EPPS BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6987
Practice Address - Country:US
Practice Address - Phone:706-979-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist