Provider Demographics
NPI:1619976420
Name:USREY, JENNIFER DIANE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DIANE
Last Name:USREY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 COUNTY ROAD 998
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:AR
Mailing Address - Zip Code:72611-9003
Mailing Address - Country:US
Mailing Address - Phone:870-743-4438
Mailing Address - Fax:870-741-0736
Practice Address - Street 1:1420 HIGHWAY 62 65 N STE A
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1959
Practice Address - Country:US
Practice Address - Phone:870-743-4438
Practice Address - Fax:870-741-0736
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142714721Medicaid
AR142714721Medicaid