Provider Demographics
NPI:1821388042
Name:DERECOLA, JENNIFER (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:DERECOLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HEARTHSTONE CT.
Mailing Address - Street 2:200
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606
Mailing Address - Country:US
Mailing Address - Phone:610-685-1761
Mailing Address - Fax:610-779-3392
Practice Address - Street 1:14128 KUTZTOWN RD.
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522
Practice Address - Country:US
Practice Address - Phone:610-944-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist