Provider Demographics
NPI:1598963365
Name:IRELAND, JENNIFER L (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:IRELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 TSIENNETO ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-437-3338
Mailing Address - Fax:603-437-3255
Practice Address - Street 1:6 TSIENNETO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-437-3338
Practice Address - Fax:603-437-3255
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH3293225100000X
MA17963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist