Provider Demographics
NPI:1720278294
Name:ALWORTH, JENNIFER (MPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:ALWORTH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WALLACE ST UNIT 213
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6620
Mailing Address - Country:US
Mailing Address - Phone:732-580-0341
Mailing Address - Fax:
Practice Address - Street 1:23 WALLACE ST UNIT 213
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6620
Practice Address - Country:US
Practice Address - Phone:732-580-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01178500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist