Provider Demographics
NPI:1851027353
Name:MORTELLITI, JEANNINE DENISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:DENISE
Last Name:MORTELLITI
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 1:129 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1893
Mailing Address - Country:US
Mailing Address - Phone:609-704-1980
Mailing Address - Fax:609-704-9054
Practice Address - Street 1:129 N WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1893
Practice Address - Country:US
Practice Address - Phone:609-704-1980
Practice Address - Fax:609-704-9054
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00658700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist