Provider Demographics
NPI:1033657341
Name:PRATT, JENNIFER MARIE OLSEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE OLSEN
Last Name:PRATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:88 MASONIC HOME RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1394
Mailing Address - Country:US
Mailing Address - Phone:508-434-3200
Mailing Address - Fax:
Practice Address - Street 1:88 MASONIC HOME RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1394
Practice Address - Country:US
Practice Address - Phone:508-434-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist