Provider Demographics
NPI:1700395563
Name:JENNINGS, JEFFERY (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 E 60 S STE B
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3835
Mailing Address - Country:US
Mailing Address - Phone:801-576-6417
Mailing Address - Fax:801-576-7536
Practice Address - Street 1:383 E 60 S STE B
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3835
Practice Address - Country:US
Practice Address - Phone:801-576-6417
Practice Address - Fax:801-576-7536
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9051839-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist