Provider Demographics
NPI:1518526102
Name:JAHNEL, HAILEY DAWN (DPT)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:DAWN
Last Name:JAHNEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:DAWN
Other - Last Name:ROUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:24007 BUSINESS HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-8235
Mailing Address - Country:US
Mailing Address - Phone:660-235-0002
Mailing Address - Fax:660-224-0108
Practice Address - Street 1:24007 BUSINESS HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-8235
Practice Address - Country:US
Practice Address - Phone:660-235-0002
Practice Address - Fax:660-224-0108
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06127225100000X
NE03485225100000X
MO11-06122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-06122OtherPHYSICAL THERAPY LICENSE
NE3946OtherPHYSICAL THERAPY LICENSE