Provider Demographics
NPI:1841844198
Name:SCUILLI, JENNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SCUILLI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:GARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:14 PARKE PLACE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2662
Mailing Address - Country:US
Mailing Address - Phone:856-256-8393
Mailing Address - Fax:856-256-8390
Practice Address - Street 1:14 PARKE PLACE BLVD STE D
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2662
Practice Address - Country:US
Practice Address - Phone:856-256-8393
Practice Address - Fax:856-256-8390
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01868500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist