Provider Demographics
NPI:1548247240
Name:CHANLEY, JENNIFER H (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:H
Last Name:CHANLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:CALVIN
Other - Last Name:CALVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:185 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-3023
Mailing Address - Country:US
Mailing Address - Phone:208-891-1440
Mailing Address - Fax:208-442-2358
Practice Address - Street 1:639 W COULTER AVE
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435
Practice Address - Country:US
Practice Address - Phone:307-754-9262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT - 2032225100000X
MO01608225100000X
WY1779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty