Provider Demographics
NPI:1336762152
Name:PRATT, JENNA LEIGH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEIGH
Last Name:PRATT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W CAPITOL AVE STE 237
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3440
Mailing Address - Country:US
Mailing Address - Phone:501-326-0514
Mailing Address - Fax:
Practice Address - Street 1:425 W CAPITOL AVE STE 237
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3440
Practice Address - Country:US
Practice Address - Phone:501-326-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist