Basic Information
| Provider Information | |||||||||
| NPI: | 1396168332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NINNESS | ||||||||
| FirstName: | JAYNE | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 OLD BRUCEVILLE ROAD | ||||||||
| Address2: | TRUREHAB | ||||||||
| City: | VINCENNES | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128864670 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4500 MEMORIAL DR. | ||||||||
| Address2: | MEMORIAL HOSPITAL | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182337750 | ||||||||
| FaxNumber: | 6182576911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2014 | ||||||||
| LastUpdateDate: | 01/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 160.003204 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.