Provider Demographics
NPI:1558401232
Name:DEVITT, JENNIFER CAROL (MSPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CAROL
Last Name:DEVITT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:JC
Other - Middle Name:
Other - Last Name:DEVITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2650 COUNTRYSIDE BLVD
Mailing Address - Street 2:C 204
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3654
Mailing Address - Country:US
Mailing Address - Phone:727-812-2377
Mailing Address - Fax:
Practice Address - Street 1:6500 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1629
Practice Address - Country:US
Practice Address - Phone:727-341-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist