Provider Demographics
NPI:1528382306
Name:GARDNER-MORGAN, JENNA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:GARDNER-MORGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 US HIGHWAY 17 STE A2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3795
Mailing Address - Country:US
Mailing Address - Phone:912-756-5699
Mailing Address - Fax:
Practice Address - Street 1:2709 US HIGHWAY 17 STE A2
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3795
Practice Address - Country:US
Practice Address - Phone:912-756-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT000993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist