Provider Demographics
NPI:1689639718
Name:MARSHALL, JENNIFER RAE-ANN (DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RAE-ANN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNEIFER
Other - Middle Name:
Other - Last Name:CHARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3649
Practice Address - Street 1:240 CEDAR KNOLLS RD
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1621
Practice Address - Country:US
Practice Address - Phone:973-998-8100
Practice Address - Fax:973-998-8099
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2755225100000X, 2251S0007X, 2251X0800X
NJ40QA01571000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154984721Medicaid
AR154984721Medicaid