Provider Demographics
NPI:1477882561
Name:FREELIN, JANNINE C (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:JANNINE
Middle Name:C
Last Name:FREELIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-0360
Mailing Address - Country:US
Mailing Address - Phone:516-374-6838
Mailing Address - Fax:516-374-2362
Practice Address - Street 1:1993 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2719
Practice Address - Country:US
Practice Address - Phone:631-242-8172
Practice Address - Fax:516-374-2362
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY19953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQA1761Medicare PIN