Provider Demographics
NPI:1386856706
Name:MENNIE, JANE FRANCES (MS,PT)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:FRANCES
Last Name:MENNIE
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BOYD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6504
Mailing Address - Country:US
Mailing Address - Phone:828-788-0081
Mailing Address - Fax:
Practice Address - Street 1:1215 KINGWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3035
Practice Address - Country:US
Practice Address - Phone:281-359-3535
Practice Address - Fax:281-359-1885
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171828225100000X
NC10729225100000X
GAPT005262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist