Provider Demographics
NPI:1588812218
Name:WENTWORTH, JENNIFER MARIE (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 MAPLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:RI
Mailing Address - Zip Code:02827-1627
Mailing Address - Country:US
Mailing Address - Phone:401-385-3424
Mailing Address - Fax:
Practice Address - Street 1:2075 NOOSENECK HILL RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6709
Practice Address - Country:US
Practice Address - Phone:401-397-8399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist