Provider Demographics
NPI:1689004434
Name:DULLY, JENNIFER F (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:F
Last Name:DULLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CANTERBURY DR W
Mailing Address - Street 2:
Mailing Address - City:PBG
Mailing Address - State:FL
Mailing Address - Zip Code:33418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 CANTERBURY DR W
Practice Address - Street 2:
Practice Address - City:PBG
Practice Address - State:FL
Practice Address - Zip Code:33418
Practice Address - Country:US
Practice Address - Phone:617-968-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist