Provider Demographics
NPI:1518995695
Name:OTTES, JEN (MPT)
Entity Type:Individual
Prefix:
First Name:JEN
Middle Name:
Last Name:OTTES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JEN
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:526 GLADSTONE RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1948
Mailing Address - Country:US
Mailing Address - Phone:267-255-9370
Mailing Address - Fax:
Practice Address - Street 1:5 W WISSAHICKON AVE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1917
Practice Address - Country:US
Practice Address - Phone:215-233-6145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ40QA09142225100000X
PAPT013411L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist