Provider Demographics
NPI:1104092063
Name:SPRAGUE, JENIFER LORRAINE (PT)
Entity type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:LORRAINE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:ALAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, CLT, CERT MDT,
Mailing Address - Street 1:2802 JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3759
Mailing Address - Country:US
Mailing Address - Phone:267-420-0966
Mailing Address - Fax:267-482-9466
Practice Address - Street 1:2802 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3759
Practice Address - Country:US
Practice Address - Phone:267-420-0966
Practice Address - Fax:267-482-9466
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012732L174400000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No174400000XOther Service ProvidersSpecialist