Provider Demographics
NPI:1194169318
Name:FISHER, JENEA GAIL (PTA)
Entity type:Individual
Prefix:MRS
First Name:JENEA
Middle Name:GAIL
Last Name:FISHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JENEA
Other - Middle Name:GAIL
Other - Last Name:LEYHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2036 US HIGHWAY 45 BYP S
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-2941
Mailing Address - Country:US
Mailing Address - Phone:731-855-4500
Mailing Address - Fax:731-855-2722
Practice Address - Street 1:2036 US HIGHWAY 45 BYP S
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-2941
Practice Address - Country:US
Practice Address - Phone:731-855-4500
Practice Address - Fax:731-855-2722
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3665225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant