Provider Demographics
NPI:1437470044
Name:ELLIS, JENNA RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:RENEE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:RENEE
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6397 KYLIE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8589
Mailing Address - Country:US
Mailing Address - Phone:941-915-3507
Mailing Address - Fax:941-343-9402
Practice Address - Street 1:2970 UNIVERSITY PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2401
Practice Address - Country:US
Practice Address - Phone:941-360-1988
Practice Address - Fax:941-360-1998
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist