Provider Demographics
NPI:1013085315
Name:SOARES, JENNIFER K (PT, DPT, CHT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:K
Last Name:SOARES
Suffix:
Gender:F
Credentials:PT, DPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1368
Mailing Address - Country:US
Mailing Address - Phone:201-847-8585
Mailing Address - Fax:201-847-0985
Practice Address - Street 1:795 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1368
Practice Address - Country:US
Practice Address - Phone:201-847-8585
Practice Address - Fax:201-847-0985
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA008731002081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine