Provider Demographics
NPI:1437302486
Name:PUGLIESE, JENIFER MOFFA (MPT)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:MOFFA
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:LYN
Other - Last Name:MOFFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:134 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5530
Mailing Address - Country:US
Mailing Address - Phone:302-731-9553
Mailing Address - Fax:
Practice Address - Street 1:3411 SILVERSIDE ROAD
Practice Address - Street 2:SPRINGER BUILDING, SUITE 105
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810
Practice Address - Country:US
Practice Address - Phone:302-478-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist