Provider Demographics
NPI:1043314297
Name:KERNAN, JENNIFER JO (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO
Last Name:KERNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JO
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 ADAMS ST
Mailing Address - Street 2:200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-394-2218
Mailing Address - Fax:303-394-0049
Practice Address - Street 1:180 ADAMS ST
Practice Address - Street 2:200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206
Practice Address - Country:US
Practice Address - Phone:303-394-2218
Practice Address - Fax:303-394-0049
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC16133Medicare ID - Type Unspecified