Provider Demographics
NPI:1932826062
Name:ROBERTS, JENNY (DPT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 W COLLEGE ST TRLR 56
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3803
Mailing Address - Country:US
Mailing Address - Phone:909-809-9003
Mailing Address - Fax:
Practice Address - Street 1:3400 LARAMIE DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2005
Practice Address - Country:US
Practice Address - Phone:406-587-0122
Practice Address - Fax:844-656-2480
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-24382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist