Provider Demographics
NPI:1790029163
Name:PICCO, JENNA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:PICCO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 KING PHILLIPS PATHE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-5702
Mailing Address - Country:US
Mailing Address - Phone:781-635-5478
Mailing Address - Fax:
Practice Address - Street 1:439 S UNION ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2837
Practice Address - Country:US
Practice Address - Phone:978-686-2983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist