Provider Demographics
NPI:1790267797
Name:LOESHELLE, JACQUELINE RUTH
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RUTH
Last Name:LOESHELLE
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 1:90 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2434
Mailing Address - Country:US
Mailing Address - Phone:908-477-3289
Mailing Address - Fax:
Practice Address - Street 1:2854 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07081-0708
Practice Address - Country:US
Practice Address - Phone:908-477-3289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist