Provider Demographics
NPI:1699432484
Name:ROBERTSON, JENNIFER (ATC, LAT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225B FALLON RD APT 441
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2938
Mailing Address - Country:US
Mailing Address - Phone:607-972-9494
Mailing Address - Fax:
Practice Address - Street 1:300 THE FENWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5820
Practice Address - Country:US
Practice Address - Phone:617-521-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer