Provider Demographics
NPI:1982842688
Name:HURT, JENNA LEIGH (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LEIGH
Last Name:HURT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 WALLACE AVE
Mailing Address - Street 2:#C2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2255
Mailing Address - Country:US
Mailing Address - Phone:502-544-3781
Mailing Address - Fax:
Practice Address - Street 1:825 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2123
Practice Address - Country:US
Practice Address - Phone:502-568-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist