Healthcare Provider Details

I. General information

NPI: 1063598530
Provider Name (Legal Business Name): JENNY DE MARZIANI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY DEMARZIANI-LARA

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SW EAGLES PKWY
GRAIN VALLEY MO
64029-8512
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 816-443-2375
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 22795
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026038871
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT034437
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: