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General NPI Number Information
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NPI Number | 1104692797
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Entity Type | Individual
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Provider Name | JENIFER LONG MSPT
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 175 HOSPITAL DR
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City | WINCHESTER
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State | KY
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Zip | 40391-9591
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Country | US
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Telephone | 859-745-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 IRVINE RD
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City | WINCHESTER
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State | KY
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Zip | 40391-7409
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Country | US
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Telephone | 703-431-4939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 008909
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License Number State | KY
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