Provider Demographics
NPI:1720564461
Name:MICHENER, JENNA NOELLE (DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NOELLE
Last Name:MICHENER
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 1:17340 PICKWICK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6182
Mailing Address - Country:US
Mailing Address - Phone:540-338-0685
Mailing Address - Fax:
Practice Address - Street 1:17340 PICKWICK DR STE 120
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6182
Practice Address - Country:US
Practice Address - Phone:540-338-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27138225100000X
VA2305213083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty