Provider Demographics
NPI:1063853828
Name:MORTON, JENNIFER C (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:MORTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:C
Other - Last Name:ARCENEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1180 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1409
Mailing Address - Country:US
Mailing Address - Phone:314-888-5233
Mailing Address - Fax:
Practice Address - Street 1:1180 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1409
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO313714YPCROtherMEDICARE PTAN