Provider Demographics
NPI:1851815963
Name:MIZNER, JENA L (PT)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:L
Last Name:MIZNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:L
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4147 NEW MEXICO AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 S BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5905
Practice Address - Country:US
Practice Address - Phone:402-462-8824
Practice Address - Fax:402-462-8017
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist