Healthcare Provider Details

I. General information

NPI: 1861316911
Provider Name (Legal Business Name): JENNA LANE CHRISTELLO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E ENON RD
YELLOW SPRINGS OH
45387-1415
US

IV. Provider business mailing address

1261 KINGSGATE RD
SPRINGFIELD OH
45503-6672
US

V. Phone/Fax

Practice location:
  • Phone: 937-767-1303
  • Fax:
Mailing address:
  • Phone: 937-408-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013429
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: