Provider Demographics
NPI:1164415097
Name:HUSELTON, JENNIFER A (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HUSELTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:NOTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:202 UNION ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1166
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:111 W PARK ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1365
Practice Address - Country:US
Practice Address - Phone:814-432-7934
Practice Address - Fax:814-432-8680
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12102558OtherCAQH
PA101662166 0005Medicaid
PA101662166 0006Medicaid
PA101662166 0002Medicaid
PA1016621660001Medicaid
PA001694595OtherHIGHMARK BLUE CROSS/ BLUE SHIELD
PA101662166 0003Medicaid
PA262004OtherHEALTH AMERICA/COVENTRY HEALTH CARE
PA101662166 0004Medicaid
PA101662166 0007Medicaid
PA101662166 0005Medicaid
PA$$$$$$$$$OtherTRICARE
PA101662166 0005Medicaid
PA101662166 0004Medicaid