Provider Demographics
NPI:1891701876
Name:CONSTENIUS, JENNIFER S (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:CONSTENIUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:S
Other - Last Name:CONSTENIUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8790 N SHADOW MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6628
Mailing Address - Country:US
Mailing Address - Phone:520-229-2020
Mailing Address - Fax:
Practice Address - Street 1:11165 N LA CANADA DR
Practice Address - Street 2:SUITE 131
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-7354
Practice Address - Country:US
Practice Address - Phone:520-547-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2318OtherSTATE LICENSE NUMBER
AZ2318OtherSTATE LICENSE NUMBER