Provider Demographics
NPI:1114551967
Name:JENNINGS, DEMETRIUS (ATC)
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2588
Mailing Address - Country:US
Mailing Address - Phone:215-667-0572
Mailing Address - Fax:
Practice Address - Street 1:1801 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-6003
Practice Address - Country:US
Practice Address - Phone:215-204-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer