Provider Demographics
NPI:1689156077
Name:DABNEY, JENNY REBECCA (MPT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:REBECCA
Last Name:DABNEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 CORTONA LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2038
Mailing Address - Country:US
Mailing Address - Phone:325-642-0035
Mailing Address - Fax:
Practice Address - Street 1:1207 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2475
Practice Address - Country:US
Practice Address - Phone:325-648-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1122869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist