Provider Demographics
NPI:1063629442
Name:ST. GEORGE, JENNIFER ADELE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ADELE
Last Name:ST. GEORGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2265
Mailing Address - Country:US
Mailing Address - Phone:267-382-0209
Mailing Address - Fax:
Practice Address - Street 1:1001 EASTON RD
Practice Address - Street 2:101 MANOR
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2028
Practice Address - Country:US
Practice Address - Phone:215-659-7759
Practice Address - Fax:215-659-6658
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist