Provider Demographics
NPI:1710061759
Name:TENNIS, JENNIFER L (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:TENNIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-1701
Mailing Address - Country:US
Mailing Address - Phone:913-731-2139
Mailing Address - Fax:
Practice Address - Street 1:21250 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8100
Practice Address - Country:US
Practice Address - Phone:913-390-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01406225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant