Provider Demographics
NPI:1477965259
Name:CROFTS, JENNA L (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:CROFTS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 RIDGELOCH PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3008
Mailing Address - Country:US
Mailing Address - Phone:920-960-4812
Mailing Address - Fax:
Practice Address - Street 1:7818 RIDGELOCH PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3008
Practice Address - Country:US
Practice Address - Phone:920-960-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-25632255A2300X
WI1530-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty