| NPI | 1316225865 |
|---|---|
| Former Name | JENNELL LYN HUMPHREY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 2319) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 005251) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2018-05-03 |