Provider Demographics
NPI:1730322231
Name:TAGLIAFERRO, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TAGLIAFERRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CONTINENTAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4341
Mailing Address - Country:US
Mailing Address - Phone:603-424-1950
Mailing Address - Fax:603-424-4749
Practice Address - Street 1:11 CONTINENTAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4341
Practice Address - Country:US
Practice Address - Phone:603-424-1950
Practice Address - Fax:603-424-4749
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3130021Medicaid