Provider Demographics
NPI:1215228382
Name:BISSONNETTE, JENNIFER LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:BISSONNETTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EASTHAMPTON RD
Mailing Address - Street 2:H13
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-7303
Mailing Address - Country:US
Mailing Address - Phone:413-563-9777
Mailing Address - Fax:
Practice Address - Street 1:20 EASTHAMPTON RD
Practice Address - Street 2:H13
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-7303
Practice Address - Country:US
Practice Address - Phone:413-563-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7889225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant