Provider Demographics
NPI:1740776145
Name:FISSINGER, JACLYN (DPT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:FISSINGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 STONYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19055-2216
Mailing Address - Country:US
Mailing Address - Phone:215-589-3895
Mailing Address - Fax:
Practice Address - Street 1:469 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1600
Practice Address - Country:US
Practice Address - Phone:215-750-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist