Provider Demographics
NPI:1659753077
Name:WINN, JENNA ALLYCE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ALLYCE
Last Name:WINN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ALLYCE
Other - Last Name:WEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1741 NE DOUGLAS ST STE 202
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4705
Practice Address - Country:US
Practice Address - Phone:816-246-2672
Practice Address - Fax:816-246-2676
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027244225100000X
KS11-05545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist