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Individual

MRS. JENNIFER L. SOUTHERN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
3008 SHAWNEE DR S, BEDFORD, IN 47421-5282
(812) 275-2468
Mailing address
101 STEEPLE RIDGE LN, BEDFORD, IN 47421-9776
(812) 275-0517

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003081A
IN

Other

Enumeration date
04/06/2015
Last updated
04/06/2015
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