Provider Demographics
NPI:1831128834
Name:IANNUCCI, JENNIFER LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:IANNUCCI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1861
Mailing Address - Country:US
Mailing Address - Phone:203-880-5221
Mailing Address - Fax:
Practice Address - Street 1:2889 FAIRFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:BRIDEGPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1744
Practice Address - Country:US
Practice Address - Phone:203-913-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic