Provider Demographics
NPI:1275534372
Name:FERTIG, JENNIFER RENEE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENEE
Last Name:FERTIG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CAMPUS CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-7901
Mailing Address - Country:US
Mailing Address - Phone:724-346-1529
Mailing Address - Fax:724-346-1498
Practice Address - Street 1:1005 CAMPUS CIR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-7901
Practice Address - Country:US
Practice Address - Phone:724-346-1529
Practice Address - Fax:724-346-1498
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010917L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001632039OtherHIGHMARK
PA081283S6ROtherMEDICARE
PA1015840140001Medicaid
PAQ20323Medicare UPIN