Provider Demographics
NPI:1134475353
Name:GAINES, JENNIFER LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:GAINES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 STATE ROAD 903
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229
Mailing Address - Country:US
Mailing Address - Phone:570-645-1880
Mailing Address - Fax:570-645-1881
Practice Address - Street 1:693 STATE ROAD 903
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229
Practice Address - Country:US
Practice Address - Phone:570-645-1880
Practice Address - Fax:570-645-1881
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist