Provider Demographics
NPI:1710108329
Name:TIMMERDING, JENNIFER MARLO (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARLO
Last Name:TIMMERDING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 BLUEGRAMA DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-6800
Mailing Address - Country:US
Mailing Address - Phone:859-534-5001
Mailing Address - Fax:859-534-5924
Practice Address - Street 1:2226 BLUEGRAMA DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-6800
Practice Address - Country:US
Practice Address - Phone:859-534-5001
Practice Address - Fax:859-534-5924
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist