Healthcare Provider Details

I. General information

NPI: 1760410971
Provider Name (Legal Business Name): JENNIFER VALE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6422 FIBLE LN
CRESTWOOD KY
40014-9726
US

IV. Provider business mailing address

PO BOX 23041
LOUISVILLE KY
40223-0041
US

V. Phone/Fax

Practice location:
  • Phone: 502-551-0611
  • Fax: 502-254-2777
Mailing address:
  • Phone: 502-551-0611
  • Fax: 502-254-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002454
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: