Provider Demographics
NPI:1548663081
Name:JERNBERG, JENNIFER R (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:JERNBERG
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 1:1100 TOWER CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-3247
Mailing Address - Country:US
Mailing Address - Phone:434-466-5153
Mailing Address - Fax:
Practice Address - Street 1:1100 TOWER CT
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-3247
Practice Address - Country:US
Practice Address - Phone:434-466-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist