Provider Demographics
NPI:1841580404
Name:DEFREITAS, JACQUELINE (DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DEFREITAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LONGWATER CIR
Mailing Address - Street 2:STE 201
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1643
Mailing Address - Country:US
Mailing Address - Phone:781-347-4686
Mailing Address - Fax:781-986-0991
Practice Address - Street 1:99 LONGWATER CIR
Practice Address - Street 2:STE 201
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1643
Practice Address - Country:US
Practice Address - Phone:781-347-4686
Practice Address - Fax:781-986-0991
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19090OtherPT LICENSE