Provider Demographics
NPI:1790115442
Name:ROSENBERGER, JACQUELINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JACQUI
Other - Middle Name:
Other - Last Name:ROSENBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:207 BECK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3316
Mailing Address - Country:US
Mailing Address - Phone:215-796-1374
Mailing Address - Fax:
Practice Address - Street 1:7112 GERMANTOWN AVE
Practice Address - Street 2:REAR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1837
Practice Address - Country:US
Practice Address - Phone:215-796-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist