Provider Demographics
NPI:1477618304
Name:ATTKISSON, JENNIFER (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ATTKISSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 DELZAN PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3503
Mailing Address - Country:US
Mailing Address - Phone:859-219-2233
Mailing Address - Fax:859-219-3322
Practice Address - Street 1:615 DELZAN PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3503
Practice Address - Country:US
Practice Address - Phone:859-219-2233
Practice Address - Fax:859-219-3322
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-004555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY617505Medicare ID - Type Unspecified