Individual
JACKIE TENCZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4331 CHURCHMAN AVE STE 102, LOUISVILLE, KY 40215-1196
(502) 366-1773
Mailing address
8714 SUMMIT RIDGE DR, LOUISVILLE, KY 40241-1380
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
TP2018074
KY
Other
Enumeration date
06/10/2018
Last updated
06/10/2018
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