Provider Demographics
NPI:1740669241
Name:BERTOLUZZI, JENNIFER ELIAS (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIAS
Last Name:BERTOLUZZI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-5031
Mailing Address - Country:US
Mailing Address - Phone:401-714-2627
Mailing Address - Fax:
Practice Address - Street 1:1600 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2939
Practice Address - Country:US
Practice Address - Phone:508-775-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist