Provider Demographics
NPI:1043307366
Name:ALLRED, JENNIFER DEE (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DEE
Last Name:ALLRED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DEE
Other - Last Name:HORINEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2001 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6621
Mailing Address - Country:US
Mailing Address - Phone:406-543-7860
Mailing Address - Fax:406-543-7862
Practice Address - Street 1:2001 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6621
Practice Address - Country:US
Practice Address - Phone:406-543-7860
Practice Address - Fax:406-543-7862
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV2075225100000X
WAPT 60285144225100000X
MTPTP-PT-LIC-9820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509577Medicaid
NV36510Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
NV100509577Medicaid