Provider Demographics
NPI:1588691000
Name:JENNINGS, CAROLE ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:CAROLE ANN
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROTHWELL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3432
Mailing Address - Country:US
Mailing Address - Phone:302-999-8626
Mailing Address - Fax:
Practice Address - Street 1:5550 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5002
Practice Address - Country:US
Practice Address - Phone:302-995-2100
Practice Address - Fax:302-998-3104
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ20000060225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant