Provider Demographics
NPI:1972184851
Name:DECKARD, JENSYNN ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENSYNN
Middle Name:ELIZABETH
Last Name:DECKARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:10801 E STATE ROUTE 350 STE B
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2384
Practice Address - Country:US
Practice Address - Phone:816-737-5502
Practice Address - Fax:816-737-5504
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06759225100000X
MO2021026426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist