Provider Demographics
NPI:1437168317
Name:CHEN, JACQUELINE MOORHEAD (PT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MOORHEAD
Last Name:CHEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3982 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1712
Mailing Address - Country:US
Mailing Address - Phone:260-483-9933
Mailing Address - Fax:260-483-9931
Practice Address - Street 1:3982 NEW VISION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1712
Practice Address - Country:US
Practice Address - Phone:260-483-9933
Practice Address - Fax:260-483-9931
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001066A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist