Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT31798 | FL |
Y | 213ES0000X | Sports Medicine | PT31798 | FL |
N | 225100000X | Physical Therapist |
NPI | 1033665211 |
---|---|
Provider Name | Jenna Kay |
First Address | Kennesaw, GA 30160-9522 |
Second Address | Ponte Vedra, FL 32082-6619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2016 |
Last Update Date | 07/05/2019 |