Provider Demographics
NPI:1457310278
Name:LASER, JENNIFER LAUREN (MSPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAUREN
Last Name:LASER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 5TH ST
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3677
Mailing Address - Country:US
Mailing Address - Phone:609-220-8644
Mailing Address - Fax:
Practice Address - Street 1:2200 WALLACE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-2578
Practice Address - Country:US
Practice Address - Phone:856-829-0015
Practice Address - Fax:856-829-0043
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01116400225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic