Provider Demographics
NPI:1437401130
Name:POPP, JENNIFER K (EDD, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:POPP
Suffix:
Gender:F
Credentials:EDD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W STADIUM AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2046
Mailing Address - Country:US
Mailing Address - Phone:765-494-3167
Mailing Address - Fax:
Practice Address - Street 1:800 W STADIUM AVE
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907
Practice Address - Country:US
Practice Address - Phone:765-494-3167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000419A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer