Provider Demographics
NPI:1124132212
Name:O'GARA, JENNIFER LEE (MPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:O'GARA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:SHEIBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2004 SPROUL RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3511
Mailing Address - Country:US
Mailing Address - Phone:610-359-1580
Mailing Address - Fax:610-359-1050
Practice Address - Street 1:2004 SPROUL RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3511
Practice Address - Country:US
Practice Address - Phone:610-359-1580
Practice Address - Fax:610-359-1050
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist