Provider Demographics
NPI:1659053908
Name:JENNEY, KRISTA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:JENNEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 S CONGRESS AVE UNIT 111
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1289
Mailing Address - Country:US
Mailing Address - Phone:512-766-2786
Mailing Address - Fax:
Practice Address - Street 1:4361 S CONGRESS AVE UNIT 111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1289
Practice Address - Country:US
Practice Address - Phone:512-766-2786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1379778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist