Healthcare Provider Details

I. General information

NPI: 1659354421
Provider Name (Legal Business Name): JACQUELYN ARMENA HAJINIAN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MARLTON PIKE E SUITE A7
CHERRY HILL NJ
08003-2150
US

IV. Provider business mailing address

346 E LANCASTER AVE #305
WYNNEWOOD PA
19096-2239
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-0993
  • Fax: 856-424-0994
Mailing address:
  • Phone: 610-642-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA01068100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: