Provider Demographics
NPI:1487734190
Name:KRAVITZ, JENNIFER R (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:KRAVITZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DOTHAN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001
Mailing Address - Country:US
Mailing Address - Phone:802-295-6350
Mailing Address - Fax:
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:GREEN MOUNTAIN PHYSICAL THERAPY LNC
Practice Address - City:W LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784
Practice Address - Country:US
Practice Address - Phone:603-298-5595
Practice Address - Fax:603-298-5205
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH0662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y009017NH01OtherBCBS
NH08Y009017NH01OtherBCBS