Provider Demographics
NPI:1598457897
Name:OLIVA, JENNA CHAGNARD (DPT)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:CHAGNARD
Last Name:OLIVA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:LYNN
Other - Last Name:CHAGNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:108 RUE LOUIS XIV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5739
Mailing Address - Country:US
Mailing Address - Phone:337-889-3106
Mailing Address - Fax:337-504-7453
Practice Address - Street 1:6331 CAMERON ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5021
Practice Address - Country:US
Practice Address - Phone:337-889-3106
Practice Address - Fax:337-504-7453
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist