Provider Demographics
NPI:1962656132
Name:FORTIER, JAYNE (MA, PT)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:
Last Name:FORTIER
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MERRICK RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2501
Mailing Address - Country:US
Mailing Address - Phone:516-255-5511
Mailing Address - Fax:
Practice Address - Street 1:303 MERRICK RD
Practice Address - Street 2:SUITE 404
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2501
Practice Address - Country:US
Practice Address - Phone:516-255-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104712251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics