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General NPI Number Information
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NPI Number | 1740810340
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Entity Type | Individual
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Provider Name | JAKE LEE JENNINGS DPT
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Gender | Male
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 1711 DALLES MILITARY RD
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City | WALLA WALLA
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State | WA
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Zip | 99362-8028
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Country | US
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Telephone | 509-529-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 500 LOCHER RD
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City | TOUCHET
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State | WA
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Zip | 99360-9648
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Country | US
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Telephone | 509-593-9602
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT61020340
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License Number State | WA
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