Healthcare Provider Details

I. General information

NPI: 1437302486
Provider Name (Legal Business Name): JENIFER MOFFA PUGLIESE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENIFER LYN MOFFA MPT

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 SILVERSIDE ROAD SPRINGER BUILDING, SUITE 105
WILMINGTON DE
19810
US

IV. Provider business mailing address

134 WOODLAWN AVE
NEWARK DE
19711-5530
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-5240
  • Fax:
Mailing address:
  • Phone: 302-731-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0001172
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: