Jenny Marie Londerholm, PT, DPT

Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Eden, TX

NPI 1134878614 · NPPES record last updated Mar 22, 2022

Key facts

NPI
1134878614
Entity type
Individual (NPI type 1)
Primary specialty
Physical Medicine & Rehabilitation Physician 208100000X
License
1309249 (TX)
Practice address
614 Eaker St
Eden, TX 76837
Phone
(325) 869-5911
Fax
(325) 869-1112
NPI assigned
Mar 22, 2022
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1309249TXMDPhysical Medicine & Rehabilitation Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 1309249 TX Yes

Addresses

Primary practice location

614 Eaker St
Eden, TX 76837

Mailing address

PO Box 987
Eden, TX 76837-0987
Phone (325) 869-5911

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address jenny.londerholm@conchoch.com Direct

Other providers in Eden, TX

All providers in Eden, TX · Physical Medicine & Rehabilitation Physician in Texas

Sources for this page

Verify at the official NPI Registry.