Provider Demographics
NPI:1942224126
Name:MULVEY, JODI E (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:E
Last Name:MULVEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:E
Other - Last Name:DEVINCENTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 EMERY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1368
Mailing Address - Country:US
Mailing Address - Phone:973-895-9925
Mailing Address - Fax:973-895-9927
Practice Address - Street 1:2 EMERY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1368
Practice Address - Country:US
Practice Address - Phone:973-895-9925
Practice Address - Fax:973-895-9927
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00548600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023997Medicare ID - Type Unspecified