MEDICARE: JENNA LAUREN HUNSAKER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	12839680-2401	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12839680-2401	OTHER	UT	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1316686058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA LAUREN HUNSAKER DPT

Provider Business Mailing Address
First Line	:	2947 S WHITE CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1913
Country	:	US
Telephone Number	:	807-675-6994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2947 S WHITE CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1913
Country	:	US
Telephone Number	:	807-675-6994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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