Basic Information
| Provider Information | |||||||||
| NPI: | 1588984249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENNINGS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47160 HOLLSTEIN DR | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440013338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403962349 | ||||||||
| FaxNumber: | 4409604646 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 LIVINGSTON AVE | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440523781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402331068 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2010 | ||||||||
| LastUpdateDate: | 04/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.