Healthcare Provider Details

I. General information

NPI: 1487734190
Provider Name (Legal Business Name): JENNIFER R KRAVITZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S MAIN ST GREEN MOUNTAIN PHYSICAL THERAPY LNC
W LEBANON NH
03784
US

IV. Provider business mailing address

110 DOTHAN ST
WHITE RIVER JUNCTION VT
05001
US

V. Phone/Fax

Practice location:
  • Phone: 603-298-5595
  • Fax: 603-298-5205
Mailing address:
  • Phone: 802-295-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNH0662
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: