Provider Demographics
NPI:1598977332
Name:TISHLER, JENNIFER SARA (MS, PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SARA
Last Name:TISHLER
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:SARA
Other - Last Name:JACKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:24 STEVENS ST
Mailing Address - Street 2:UNIT 8 WEST
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3852
Mailing Address - Country:US
Mailing Address - Phone:917-232-2712
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3815
Practice Address - Country:US
Practice Address - Phone:203-852-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist