Provider Demographics
NPI:1912238262
Name:SKARA, JENNIFER (MPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SKARA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BONOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:525 CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2545
Mailing Address - Country:US
Mailing Address - Phone:908-654-4252
Mailing Address - Fax:908-654-4258
Practice Address - Street 1:525 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2545
Practice Address - Country:US
Practice Address - Phone:908-654-4252
Practice Address - Fax:908-654-4258
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00865300225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist