Provider Demographics
NPI:1053607598
Name:HAMILTON, JENNA L (PT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:L
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17134 BEL RAY PL
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-5331
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:3405 NW HUNTERS RIDGE TER
Practice Address - Street 2:#300
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2509
Practice Address - Country:US
Practice Address - Phone:785-246-2300
Practice Address - Fax:785-246-2301
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1053607598OtherBCBS KS