Provider Demographics
NPI:1306259593
Name:YORK, JENNA (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 LOWER ELKTON RD
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-8629
Mailing Address - Country:US
Mailing Address - Phone:330-727-2142
Mailing Address - Fax:
Practice Address - Street 1:103 BASTIANI DR
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1604
Practice Address - Country:US
Practice Address - Phone:330-727-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207195225100000X
OH013109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist