Provider Demographics
NPI:1144303694
Name:JENNINGS, LAURA KATHLEEN (PT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KATHLEEN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 GEYER SPRINGS RD
Mailing Address - Street 2:SUITE 1-S
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-2727
Mailing Address - Country:US
Mailing Address - Phone:501-570-4004
Mailing Address - Fax:501-570-4003
Practice Address - Street 1:6917 GEYER SPRINGS RD
Practice Address - Street 2:SUITE 1-S
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-2727
Practice Address - Country:US
Practice Address - Phone:501-570-4004
Practice Address - Fax:501-570-4003
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142985721Medicaid
AR5W757OtherBCBS