Provider Demographics
NPI:1942943089
Name:MYERS, JENNA MARIE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W 80 1/2 ST UNIT 315
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-7101
Mailing Address - Country:US
Mailing Address - Phone:319-329-7008
Mailing Address - Fax:
Practice Address - Street 1:1901 W 80 1/2 ST UNIT 226
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-5108
Practice Address - Country:US
Practice Address - Phone:319-329-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer