Provider Demographics
NPI:1689078230
Name:YESSIN, JENNIFER (PT, MSED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:YESSIN
Suffix:
Gender:F
Credentials:PT, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1732
Mailing Address - Country:US
Mailing Address - Phone:859-396-2135
Mailing Address - Fax:
Practice Address - Street 1:248 CLAY AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1732
Practice Address - Country:US
Practice Address - Phone:859-396-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist