Provider Demographics
NPI:1457634255
Name:MARTORELLI, JENNA NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:MARTORELLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:NICOLE
Other - Last Name:HABLENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:146 BIRCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1833
Mailing Address - Country:US
Mailing Address - Phone:516-759-9717
Mailing Address - Fax:519-759-1666
Practice Address - Street 1:146 BIRCH HILL RD
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-1833
Practice Address - Country:US
Practice Address - Phone:516-759-9717
Practice Address - Fax:519-759-1666
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0343301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist