Provider Demographics
NPI:1396022844
Name:DEFREZE, JENNIFER MAE
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MAE
Last Name:DEFREZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1244
Mailing Address - Country:US
Mailing Address - Phone:585-349-2860
Mailing Address - Fax:
Practice Address - Street 1:37 N UNION ST
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1244
Practice Address - Country:US
Practice Address - Phone:585-349-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist