Provider Demographics
NPI:1285769877
Name:WUNDERLICH, JENNIFER N (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:BRAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2010 N BEND RD STE 600
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-8003
Mailing Address - Country:US
Mailing Address - Phone:859-594-5220
Mailing Address - Fax:
Practice Address - Street 1:2010 N BEND RD STE 600
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-8003
Practice Address - Country:US
Practice Address - Phone:859-594-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007035225100000X
MO2008002911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist