Provider Demographics
NPI:1508865379
Name:PERNO, JENNIFER LYNNE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:PERNO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PARKE PLACE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2661
Mailing Address - Country:US
Mailing Address - Phone:856-256-8393
Mailing Address - Fax:856-256-8390
Practice Address - Street 1:14 PARKE PLACE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2661
Practice Address - Country:US
Practice Address - Phone:856-256-8393
Practice Address - Fax:856-256-8390
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA009601002251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2107652OtherFIRST HEALTH
NJ1555347OtherAMERIHEALTH
NJ51405OtherORTHONET
NJ51405OtherORTHONET