Provider Demographics
NPI:1386061984
Name:PORTNOY, JENNIFER RAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:PORTNOY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 PINEHURST CT
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-3071
Mailing Address - Country:US
Mailing Address - Phone:267-625-5693
Mailing Address - Fax:
Practice Address - Street 1:407 PINEHURST CT
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-3071
Practice Address - Country:US
Practice Address - Phone:267-625-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011159L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist