Provider Demographics
NPI:1114242880
Name:MCAULEY, JENNIFER ADRIENNE (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ADRIENNE
Last Name:MCAULEY
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 1:75 MABEL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2514
Mailing Address - Country:US
Mailing Address - Phone:207-553-0398
Mailing Address - Fax:
Practice Address - Street 1:619 BRIGHTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2373
Practice Address - Country:US
Practice Address - Phone:207-879-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3989225100000X, 2251X0800X
NY0263912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist