Provider Demographics
NPI:1558685370
Name:MENZEN, JESSICA LEE (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MENZEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1203
Mailing Address - Country:US
Mailing Address - Phone:609-954-6892
Mailing Address - Fax:
Practice Address - Street 1:1807 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1203
Practice Address - Country:US
Practice Address - Phone:609-954-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002181225200000X
NJ40QB00257100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant