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General NPI Number Information
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NPI Number | 1487469664
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Entity Type | Individual
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Provider Name | JENNA LUCRETIA VAIN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1901 N MACARTHUR BLVD
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City | IRVING
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State | TX
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Zip | 75061-2220
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Country | US
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Telephone | 972-579-8510
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 MAPLE AVE APT 5410
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City | DALLAS
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State | TX
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Zip | 75235-8451
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Country | US
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Telephone | 423-443-1021
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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 | 1404791
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License Number State | TX
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