Provider Demographics
NPI:1598831810
Name:DEVITA, JENNIFER SANDRA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SANDRA
Last Name:DEVITA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 JARED DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5519
Mailing Address - Country:US
Mailing Address - Phone:732-309-1495
Mailing Address - Fax:
Practice Address - Street 1:73 JARED DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5519
Practice Address - Country:US
Practice Address - Phone:732-309-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00880000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist