Provider Demographics
NPI:1114270865
Name:GREENBERG, JENNIFER LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 PEBBLE BEACH LANE
Mailing Address - Street 2:PEBBLE BEACH PHYSICAL THERAPY, PLLC
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605
Mailing Address - Country:US
Mailing Address - Phone:914-946-3304
Mailing Address - Fax:
Practice Address - Street 1:5 PEBBLE BEACH LN
Practice Address - Street 2:PEBBLE BEACH PHYSICAL THERAPY, PLLC
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5117
Practice Address - Country:US
Practice Address - Phone:914-946-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012122-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist