Provider Demographics
NPI:1609909894
Name:FOURNIER, JENNIFER MARIE (BS, PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:BS, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PAMELA LN
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1549
Mailing Address - Country:US
Mailing Address - Phone:603-895-1290
Mailing Address - Fax:
Practice Address - Street 1:96 FOREST ST
Practice Address - Street 2:PILGRIM REHAB & NURSING CENTER
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3907
Practice Address - Country:US
Practice Address - Phone:978-532-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3789225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant