Provider Demographics
NPI:1568533875
Name:DIBERT, JENNIFER MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:DIBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:210 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:PA
Mailing Address - Zip Code:16695-9432
Mailing Address - Country:US
Mailing Address - Phone:814-766-2320
Mailing Address - Fax:
Practice Address - Street 1:1798 OLD ROUTE 220 N
Practice Address - Street 2:SUITE 103
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8341
Practice Address - Country:US
Practice Address - Phone:814-696-3400
Practice Address - Fax:814-696-3402
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002703L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant