Provider Demographics
NPI:1912380676
Name:PFLUG, JENNIFER A (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:PFLUG
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 1:220 BEAR HILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1004
Mailing Address - Country:US
Mailing Address - Phone:781-790-8479
Mailing Address - Fax:781-281-9181
Practice Address - Street 1:220 BEAR HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1004
Practice Address - Country:US
Practice Address - Phone:781-790-8479
Practice Address - Fax:781-281-9181
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist