Provider Demographics
NPI:1710877865
Name:ATLAS, JENNA MIMI (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:MIMI
Last Name:ATLAS
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DOWD AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2401
Mailing Address - Country:US
Mailing Address - Phone:860-245-1049
Mailing Address - Fax:860-422-4983
Practice Address - Street 1:141 DOWD AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2401
Practice Address - Country:US
Practice Address - Phone:860-245-1049
Practice Address - Fax:860-422-4983
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT014564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist