Individual
MRS. HEATHER SUE JENNY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3344 PIAZZA LN, EDWARDSVILLE, IL 62025-3225
(402) 680-9272
Mailing address
3344 PIAZZA LN, EDWARDSVILLE, IL 62025-3225
(402) 680-9272
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
941
NE
225100000X
Physical Therapist
—
—
2251G0304X
Geriatric Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
941
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025508900
—
NE
05
—
10025670600
—
NE
Enumeration date
09/21/2010
Last updated
09/11/2015
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