Provider Demographics
NPI:1437471117
Name:HARSHBARGER, JENNY MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MICHELLE
Last Name:HARSHBARGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:MICHELLE
Other - Last Name:BREDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 SAINT ANTHONYS WAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4568
Mailing Address - Country:US
Mailing Address - Phone:618-463-5683
Mailing Address - Fax:618-463-5647
Practice Address - Street 1:1 SAINT ANTHONYS WAY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4568
Practice Address - Country:US
Practice Address - Phone:618-463-5683
Practice Address - Fax:618-463-5647
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist