Provider Demographics
NPI:1699859272
Name:ROSEN, JENNIFER A (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:ROSEN
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 1:95 BELVOIR RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3615
Mailing Address - Country:US
Mailing Address - Phone:716-531-9037
Mailing Address - Fax:
Practice Address - Street 1:4242 RIDGE LEA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1051
Practice Address - Country:US
Practice Address - Phone:716-819-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026345-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist