Provider Demographics
NPI:1386148286
Name:GILLESPIE, JENNIFER R (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:GILLESPIE
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 1:40 TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1622
Mailing Address - Country:US
Mailing Address - Phone:201-207-8253
Mailing Address - Fax:
Practice Address - Street 1:3219 US HIGHWAY 46 STE 101
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1283
Practice Address - Country:US
Practice Address - Phone:973-299-2199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01776000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist