Provider Demographics
NPI:1649883869
Name:BROPHY, JENA MARIE
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:MARIE
Last Name:BROPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 RAINBOW BLVD APT 722
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2089
Mailing Address - Country:US
Mailing Address - Phone:314-603-2268
Mailing Address - Fax:
Practice Address - Street 1:2 EMANUEL CLEAVER II BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1654
Practice Address - Country:US
Practice Address - Phone:503-376-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020027875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist