Provider Demographics
NPI:1619044419
Name:MORRISSEY, JEAN A (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:A
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:76 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07422-1021
Mailing Address - Country:US
Mailing Address - Phone:973-764-0313
Mailing Address - Fax:
Practice Address - Street 1:2 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1402
Practice Address - Country:US
Practice Address - Phone:845-294-8806
Practice Address - Fax:845-294-8650
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008131-1225100000X
NJ40QA00601300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ48401OtherEMPIREBLUECROSSBLUESHIELD
NY87764OtherGHI
NY87764OtherGHI