Healthcare Provider Details

I. General information

NPI: 1972037620
Provider Name (Legal Business Name): JENNY TLATENCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16405 NORTHCROSS DR SUITE G-2
HUNTERSVILLE NC
28078-5091
US

IV. Provider business mailing address

16405 NORTHCROSS DR SUITE G-2
HUNTERSVILLE NC
28078-5091
US

V. Phone/Fax

Practice location:
  • Phone: 866-214-9644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160006141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: