Provider Demographics
NPI:1972098846
Name:KIENSTRA, JENNIFER CAROLE (DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CAROLE
Last Name:KIENSTRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 37TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-9508
Mailing Address - Country:US
Mailing Address - Phone:320-227-2606
Mailing Address - Fax:
Practice Address - Street 1:1 LOVE LN
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3445
Practice Address - Country:US
Practice Address - Phone:508-385-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist