Provider Demographics
NPI:1962442137
Name:MATHERS, JENIFER JO (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:JO
Last Name:MATHERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JENIFER
Other - Middle Name:JO
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1454 30TH STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1312
Mailing Address - Country:US
Mailing Address - Phone:515-223-6620
Mailing Address - Fax:515-223-9625
Practice Address - Street 1:1454 30TH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1312
Practice Address - Country:US
Practice Address - Phone:515-223-6620
Practice Address - Fax:515-223-9625
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00359225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant