Provider Demographics
NPI:1124068382
Name:PAULOSKY, JENNIFER (PT/ ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PAULOSKY
Suffix:
Gender:F
Credentials:PT/ ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 KATHMERE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3931
Mailing Address - Country:US
Mailing Address - Phone:610-446-9337
Mailing Address - Fax:
Practice Address - Street 1:20 W BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2101
Practice Address - Country:US
Practice Address - Phone:610-626-0080
Practice Address - Fax:610-626-0084
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007614L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist