Provider Demographics
NPI:1093848996
Name:LONG, JAYNE ELLEN (PT)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:ELLEN
Last Name:LONG
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:2805 CAMPUS DR STE 345
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2679
Mailing Address - Country:US
Mailing Address - Phone:763-236-5555
Mailing Address - Fax:
Practice Address - Street 1:2805 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2676
Practice Address - Country:US
Practice Address - Phone:763-236-5555
Practice Address - Fax:763-236-5557
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN27022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic