Provider Demographics
NPI:1457779688
Name:MASSAR, JENNIFER (PT MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MASSAR
Suffix:
Gender:F
Credentials:PT MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 CLEVELAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3625
Mailing Address - Country:US
Mailing Address - Phone:330-484-2547
Mailing Address - Fax:338-484-3431
Practice Address - Street 1:3057 CLEVELAND AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3625
Practice Address - Country:US
Practice Address - Phone:330-484-2547
Practice Address - Fax:338-484-3431
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist