Healthcare Provider Details

I. General information

NPI: 1588691000
Provider Name (Legal Business Name): CAROLE ANN JENNINGS P.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 KIRKWOOD HWY
WILMINGTON DE
19808-5002
US

IV. Provider business mailing address

16 ROTHWELL DR
WILMINGTON DE
19804-3432
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-2100
  • Fax: 302-998-3104
Mailing address:
  • Phone: 302-999-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ20000060
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: