Provider Demographics
NPI:1740810340
Name:JENNINGS, JAKE LEE (DPT)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:LEE
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LOCHER RD
Mailing Address - Street 2:
Mailing Address - City:TOUCHET
Mailing Address - State:WA
Mailing Address - Zip Code:99360-9648
Mailing Address - Country:US
Mailing Address - Phone:509-593-9602
Mailing Address - Fax:
Practice Address - Street 1:1711 DALLES MILITARY RD
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8028
Practice Address - Country:US
Practice Address - Phone:509-529-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT610203402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic