Individual
JENNY SUE EVERSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2827 NORTHGATE BLVD, FORT WAYNE, IN 46835-2900
(260) 715-2850
Mailing address
5837 W WALLEN RD, FORT WAYNE, IN 46818-9363
(260) 715-2850
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
06002991A
IN
Other
Enumeration date
01/20/2010
Last updated
01/20/2010
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