Provider Demographics
NPI:1669010120
Name:FAIELLA, JENNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FAIELLA
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 1:1245 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9481
Mailing Address - Country:US
Mailing Address - Phone:440-539-8599
Mailing Address - Fax:
Practice Address - Street 1:3806 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2516
Practice Address - Country:US
Practice Address - Phone:925-689-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist