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General NPI Number Information
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NPI Number | 1508559808
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Entity Type | Individual
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Provider Name | JENNA LARUE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1227 GOSS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40217-1239
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Country | US
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Telephone | 502-636-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 6156 SOUTHAMPTON DR
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City | DAYTON
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State | OH
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Zip | 45459-1913
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Country | US
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Telephone | 937-776-3412
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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 | PT020577
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-009048
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License Number State | KY
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