Provider Demographics
NPI:1669818688
Name:JUAREZ, JENNA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:GATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11910 W BRITTON ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-992-0739
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:510 WHEATRIGDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114
Practice Address - Country:US
Practice Address - Phone:316-836-4700
Practice Address - Fax:316-836-4750
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist