Provider Demographics
NPI:1710179122
Name:WIRCH, JENNIFER LYNNE (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:WIRCH
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 1:22 AMOS LEHMAN WAY
Mailing Address - Street 2:
Mailing Address - City:STOUFFVILLE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4A0J9
Mailing Address - Country:CA
Mailing Address - Phone:905-591-0784
Mailing Address - Fax:
Practice Address - Street 1:22 AMOS LEHMAN WAY
Practice Address - Street 2:
Practice Address - City:STOUFFVILLE
Practice Address - State:ONTARIO
Practice Address - Zip Code:L4A0J9
Practice Address - Country:CA
Practice Address - Phone:905-591-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist