Provider Demographics
NPI:1255869764
Name:DISIPIO, JENNIFER KAY (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:DISIPIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KAY
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6381 EGRET DR APT 19
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-6620
Mailing Address - Country:US
Mailing Address - Phone:863-640-5302
Mailing Address - Fax:
Practice Address - Street 1:6381 EGRET DR APT 19
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-6620
Practice Address - Country:US
Practice Address - Phone:863-640-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT191202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic