Provider Demographics
NPI:1437769437
Name:STERNASTY, JENELLE LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JENELLE
Middle Name:LYNN
Last Name:STERNASTY
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 1:5823 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4167
Mailing Address - Country:US
Mailing Address - Phone:219-309-8803
Mailing Address - Fax:
Practice Address - Street 1:5823 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4167
Practice Address - Country:US
Practice Address - Phone:219-309-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013793A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics