Provider Demographics
NPI:1629693908
Name:DUNN, JACLYN JOANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:JOANNE
Last Name:DUNN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:JOANNE
Other - Last Name:TILLOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1111
Mailing Address - Country:US
Mailing Address - Phone:732-682-4240
Mailing Address - Fax:
Practice Address - Street 1:1725 MERIDIAN TRL
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3869
Practice Address - Country:US
Practice Address - Phone:732-312-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01643700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist