Provider Demographics
NPI:1356548614
Name:SMALL, JENNIFER BETH (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BETH
Last Name:SMALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:923 MUD COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-9584
Mailing Address - Country:US
Mailing Address - Phone:270-298-3644
Mailing Address - Fax:270-298-3644
Practice Address - Street 1:313 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FORDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42343
Practice Address - Country:US
Practice Address - Phone:270-276-3603
Practice Address - Fax:270-276-3609
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY002883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist