Provider Demographics
NPI:1710321567
Name:BAUMBERGER, JENNIE LYNNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:LYNNE
Last Name:BAUMBERGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 DOLPHIN ST
Mailing Address - Street 2:#3
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7037
Mailing Address - Country:US
Mailing Address - Phone:501-749-4922
Mailing Address - Fax:
Practice Address - Street 1:1508 DOLPHIN ST
Practice Address - Street 2:#3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7037
Practice Address - Country:US
Practice Address - Phone:501-749-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist