Provider Demographics
NPI:1477986693
Name:FOX, JENNAH SUZANNE (DPT)
Entity Type:Individual
Prefix:
First Name:JENNAH
Middle Name:SUZANNE
Last Name:FOX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 PETERS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:PA
Mailing Address - Zip Code:17032-8605
Mailing Address - Country:US
Mailing Address - Phone:717-896-7612
Mailing Address - Fax:717-896-7617
Practice Address - Street 1:3771 PETERS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8605
Practice Address - Country:US
Practice Address - Phone:717-896-7612
Practice Address - Fax:717-896-7617
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist