Provider Demographics
NPI:1578946562
Name:GRASINGER, JENNIFER LYNN (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:GRASINGER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0248
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:118 MAIN ST
Practice Address - Street 2:
Practice Address - City:TIDIOUTE
Practice Address - State:PA
Practice Address - Zip Code:16351-1056
Practice Address - Country:US
Practice Address - Phone:814-484-1100
Practice Address - Fax:814-484-1102
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008524L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007575500027Medicaid
PA1007575500029Medicaid