Provider Demographics
NPI:1689898769
Name:SUMMEY, JENNIFER LYNN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SUMMEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:SUSONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:2670 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-5913
Mailing Address - Country:US
Mailing Address - Phone:423-639-0470
Mailing Address - Fax:
Practice Address - Street 1:801 E MCKEE ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-6010
Practice Address - Country:US
Practice Address - Phone:423-638-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3028225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant