Provider Demographics
NPI:1750660569
Name:CARLISLE, JENNIFER (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CARLISLE
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 1:107 S HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3862
Mailing Address - Country:US
Mailing Address - Phone:732-672-9554
Mailing Address - Fax:732-295-1749
Practice Address - Street 1:107 S HAMPTON PL
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3862
Practice Address - Country:US
Practice Address - Phone:732-672-9554
Practice Address - Fax:732-295-1749
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01400900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist