Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
JENELLE DEATHERAGE
Active
Individual
JENELLE DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070020706
IL
225100000X
Physical Therapist
7357
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070020706
ILLINOIS PT LICENSE NO.
IL
Enumeration date
08/13/2006
Last updated
06/26/2014
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