Provider Demographics
NPI:1891731246
Name:ELEY, JENNIFER LEE (MPT, CHT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:ELEY
Suffix:
Gender:F
Credentials:MPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 NEWPORT GAP PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6208
Mailing Address - Country:US
Mailing Address - Phone:302-633-5840
Mailing Address - Fax:302-633-5844
Practice Address - Street 1:750 PRIDES XING
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6104
Practice Address - Country:US
Practice Address - Phone:302-864-2222
Practice Address - Fax:302-907-4028
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014287L225100000X
DEJ1001064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEJ10001084OtherDE LICENSE
DEJ10001084OtherDE LICENSE
P00400296OtherRR MEDICARE
2002947000OtherAMERIHEALTH IBC
291885OtherMAMSI
DE1000037700Medicaid
5070-0006OtherCARE FIRST
61809501OtherNCA
2002947000OtherAMERIHEALTH
61809501OtherNCA
5070-0006OtherCARE FIRST
DEG02378A11Medicare PIN