Provider Demographics
NPI:1902416043
Name:GASPERLIN, JENNA (PT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GASPERLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 MAIN ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1578
Mailing Address - Country:US
Mailing Address - Phone:612-270-9979
Mailing Address - Fax:
Practice Address - Street 1:657 MAIN ST NW STE 102
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1578
Practice Address - Country:US
Practice Address - Phone:612-270-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics