Provider Demographics
NPI:1275811234
Name:NADEAU, JENNIFER ROSE (DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ROSE
Last Name:NADEAU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:HUSSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 DAVIS POINT LN
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2620
Mailing Address - Country:US
Mailing Address - Phone:207-767-9773
Mailing Address - Fax:
Practice Address - Street 1:2 DAVIS POINT LN
Practice Address - Street 2:SUITE 1A
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2620
Practice Address - Country:US
Practice Address - Phone:207-767-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist