Provider Demographics
NPI:1568248532
Name:ALLEN, JENNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 PALO DURO CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7171
Mailing Address - Country:US
Mailing Address - Phone:136-177-2664
Mailing Address - Fax:
Practice Address - Street 1:3880 GRANT AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8433
Practice Address - Country:US
Practice Address - Phone:970-663-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
COCP033678T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist