Provider Demographics
NPI:1689796492
Name:STURTEVANT, JENNIFER (LATC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:STURTEVANT
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LAKESHORE AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1908
Mailing Address - Country:US
Mailing Address - Phone:617-827-5311
Mailing Address - Fax:781-395-5343
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-395-7750
Practice Address - Fax:781-395-5343
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer