Provider Demographics
NPI:1528340429
Name:HANCOCK, JENNEE B (PTA)
Entity type:Individual
Prefix:MS
First Name:JENNEE
Middle Name:B
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JENNEE
Other - Middle Name:B
Other - Last Name:CHRISTOFFERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4949 S AMARO DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4949 S AMARO DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-5733
Practice Address - Country:US
Practice Address - Phone:720-232-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPTA-0634225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant