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General NPI Number Information
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NPI Number | 1639773302
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Entity Type | Individual
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Provider Name | JENELLE MICHELLE HUNNICUTT DPT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 500 LAWRENCE ST
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City | BALDWIN CITY
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State | KS
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Zip | 66006-3022
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Country | US
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Telephone | 520-250-3241
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Fax |
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Provider Business Mailing Address
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Address Line | 12924 BRIAR DR
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City | LEAWOOD
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State | KS
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Zip | 66209-1867
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Country | US
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Telephone | 520-250-3241
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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 | 11-06423
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License Number State | KS
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