Healthcare Provider Details

I. General information

NPI: 1336377076
Provider Name (Legal Business Name): JENNIFER SUE FOLAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PARK DR
WESTFORD MA
01886-3511
US

IV. Provider business mailing address

17 EAST ST
PEPPERELL MA
01463-1702
US

V. Phone/Fax

Practice location:
  • Phone: 978-392-1144
  • Fax:
Mailing address:
  • Phone: 978-433-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: