Provider Demographics
NPI:1619238623
Name:BEHER, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:BEHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 E 1450 N
Mailing Address - Street 2:
Mailing Address - City:SUMMITVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46070-9010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4725 S COLONIAL OAKS DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5341
Practice Address - Country:US
Practice Address - Phone:765-674-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99052105A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant