Healthcare Provider Details

I. General information

NPI: 1114551322
Provider Name (Legal Business Name): CAROLINE JENETS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 WALNUT ST
MCKEESPORT PA
15132-2806
US

IV. Provider business mailing address

115 PERRY HWY STE 136
HARMONY PA
16037-9205
US

V. Phone/Fax

Practice location:
  • Phone: 412-673-5005
  • Fax:
Mailing address:
  • Phone: 724-452-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT028357
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: