Provider Demographics
NPI:1760690168
Name:MURPHY, JENNIFER MARIE (PTA, MT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PTA, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 COUNTY ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:MADRID
Mailing Address - State:NY
Mailing Address - Zip Code:13660-3161
Mailing Address - Country:US
Mailing Address - Phone:315-322-4074
Mailing Address - Fax:
Practice Address - Street 1:80 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1450
Practice Address - Country:US
Practice Address - Phone:315-261-5490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003241-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist