Provider Demographics
NPI:1891003844
Name:CAIN, JENNA LYNE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LYNE
Last Name:CAIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:LYNE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:360 E. ENON RD
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387
Mailing Address - Country:US
Mailing Address - Phone:937-767-1303
Mailing Address - Fax:937-236-8930
Practice Address - Street 1:360 E. ENON RD
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387
Practice Address - Country:US
Practice Address - Phone:937-767-1303
Practice Address - Fax:937-236-8930
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT. 012838171W00000X
OH012838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor