Provider Demographics
NPI:1639773302
Name:HUNNICUTT, JENELLE MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:MICHELLE
Last Name:HUNNICUTT
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 1:12924 BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1867
Mailing Address - Country:US
Mailing Address - Phone:520-250-3241
Mailing Address - Fax:
Practice Address - Street 1:500 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-3022
Practice Address - Country:US
Practice Address - Phone:520-250-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist