Provider Demographics
NPI:1174948459
Name:BALL, JENA (PT)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:DES JARDINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:5703 GULF TECH DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-8238
Mailing Address - Country:US
Mailing Address - Phone:228-875-5447
Mailing Address - Fax:228-875-5448
Practice Address - Street 1:8905 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4421
Practice Address - Country:US
Practice Address - Phone:228-215-0521
Practice Address - Fax:228-215-0619
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist