Provider Demographics
NPI:1609328392
Name:ENGELKEN, JENNA ROSE (PTA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:ENGELKEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2548
Mailing Address - Country:US
Mailing Address - Phone:140-233-9770
Mailing Address - Fax:
Practice Address - Street 1:610 S POLK ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2548
Practice Address - Country:US
Practice Address - Phone:140-233-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14542251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics