Provider Demographics
NPI:1366796633
Name:KLEMANN, JENNICA SUZANNE (MT)
Entity type:Individual
Prefix:
First Name:JENNICA
Middle Name:SUZANNE
Last Name:KLEMANN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:JENNICA
Other - Middle Name:SUZANNE
Other - Last Name:BROWNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:6955 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4224
Mailing Address - Country:US
Mailing Address - Phone:520-334-1919
Mailing Address - Fax:520-638-7704
Practice Address - Street 1:6955 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4224
Practice Address - Country:US
Practice Address - Phone:520-334-1919
Practice Address - Fax:520-638-7704
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-04771P172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist