Provider Demographics
NPI:1720651300
Name:PRINCELL, JENELL (DPT)
Entity type:Individual
Prefix:
First Name:JENELL
Middle Name:
Last Name:PRINCELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-9749
Mailing Address - Country:US
Mailing Address - Phone:740-504-3761
Mailing Address - Fax:
Practice Address - Street 1:6659 LIBERTY CT
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9538
Practice Address - Country:US
Practice Address - Phone:513-204-9071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014268A225100000X
OH013252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist