Provider Demographics
NPI:1306081120
Name:ROXAS, JENNIFER (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:ROXAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:BARAQUIO
Other - Last Name:ROXAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1650 SELWYN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7626
Mailing Address - Country:US
Mailing Address - Phone:718-579-3940
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-518-5200
Practice Address - Fax:718-518-5818
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029341-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist