Provider Demographics
NPI:1821462870
Name:SPAHN, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SPAHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8860 EFFINGER RD
Mailing Address - Street 2:
Mailing Address - City:WADESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47638-8505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 IN-66
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:IN
Practice Address - Zip Code:47631
Practice Address - Country:US
Practice Address - Phone:812-682-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011535A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist