Provider Demographics
NPI:1427235936
Name:HARDIN, JENNIFER DEAN (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DEAN
Last Name:HARDIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 SCHERM RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5300
Mailing Address - Country:US
Mailing Address - Phone:270-663-6050
Mailing Address - Fax:270-663-6051
Practice Address - Street 1:1605 SCHERM RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5300
Practice Address - Country:US
Practice Address - Phone:270-663-6050
Practice Address - Fax:270-663-6051
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000549724OtherBLUE CROSS BLUE SHIELD
KY000000549724OtherBLUE CROSS BLUE SHIELD