Provider Demographics
NPI:1497922363
Name:BAINTON, JENNIFER AMY (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMY
Last Name:BAINTON
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 SYCAMORE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5875
Mailing Address - Country:US
Mailing Address - Phone:775-841-0220
Mailing Address - Fax:
Practice Address - Street 1:201 KOONTZ LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5513
Practice Address - Country:US
Practice Address - Phone:775-883-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist