Provider Demographics
NPI:1265596407
Name:MENKE, JENNIFER MICHELE (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELE
Last Name:MENKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MICHELE
Other - Last Name:SAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03256-0715
Mailing Address - Country:US
Mailing Address - Phone:603-677-3985
Mailing Address - Fax:
Practice Address - Street 1:15 TOWN WEST RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3428
Practice Address - Country:US
Practice Address - Phone:603-536-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30394880Medicaid