Provider Demographics
NPI:1386983344
Name:SONSINI, JACQUELINE S (PT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:SONSINI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:GELINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:322 FORREST LN
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-3328
Mailing Address - Country:US
Mailing Address - Phone:609-442-5298
Mailing Address - Fax:
Practice Address - Street 1:322 FORREST LN
Practice Address - Street 2:
Practice Address - City:WOOLWICH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-3328
Practice Address - Country:US
Practice Address - Phone:609-442-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NJ40QA01472000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ273077Medicare PIN