Provider Demographics
NPI:1063932481
Name:DANLEY, JENNIFER LYNNE (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:DANLEY
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 1:178 BRADLEY ST APT A
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3103
Mailing Address - Country:US
Mailing Address - Phone:207-632-8388
Mailing Address - Fax:
Practice Address - Street 1:381 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1361
Practice Address - Country:US
Practice Address - Phone:207-839-9090
Practice Address - Fax:207-839-9091
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist