Provider Demographics
NPI:1356223598
Name:CALVELAGE, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:CALVELAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 S FORT THOMAS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2315
Mailing Address - Country:US
Mailing Address - Phone:859-592-0140
Mailing Address - Fax:859-448-5214
Practice Address - Street 1:1029 S FORT THOMAS AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2315
Practice Address - Country:US
Practice Address - Phone:859-592-0140
Practice Address - Fax:859-448-5214
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist