Provider Demographics
NPI:1598457897
Name:CHAGNARD, JENNA LYNN (DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LYNN
Last Name:CHAGNARD
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 1:9462 ELLERBE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7466
Mailing Address - Country:US
Mailing Address - Phone:318-606-5262
Mailing Address - Fax:318-402-0802
Practice Address - Street 1:5795 N MARKET ST STE 8
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2527
Practice Address - Country:US
Practice Address - Phone:318-489-4298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist