Provider Demographics
NPI:1912977919
Name:SPERI, JENNIFER N (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:SPERI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:QUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10940 RAVEN RIDGE RD
Mailing Address - Street 2:#110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6610
Mailing Address - Country:US
Mailing Address - Phone:919-518-0420
Mailing Address - Fax:919-518-0421
Practice Address - Street 1:10940 RAVEN RIDGE RD
Practice Address - Street 2:#110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6610
Practice Address - Country:US
Practice Address - Phone:919-518-0420
Practice Address - Fax:919-518-0421
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078WEOtherBLUE CROSS BLUE SHIELD
NCD9502OtherMEDCOST
NC5947795OtherAETNA
NC5947795OtherAETNA