Provider Demographics
NPI:1871828376
Name:STANKEY, JENNY LYNN (LPT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:STANKEY
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LYNN
Other - Last Name:DABERKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1810 4TH ST SW STE 103A
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-4389
Mailing Address - Country:US
Mailing Address - Phone:319-352-6400
Mailing Address - Fax:319-352-4655
Practice Address - Street 1:1810 4TH ST SW STE 103A
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-4389
Practice Address - Country:US
Practice Address - Phone:319-352-6400
Practice Address - Fax:319-352-4655
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665992Medicaid
IA166599Medicare Oscar/Certification