Healthcare Provider Details

I. General information

NPI: 1831689694
Provider Name (Legal Business Name): JACKI KETNER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 EGG HARBOR RD STE C4
SEWELL NJ
08080-2359
US

IV. Provider business mailing address

4 EVES DR STE A100
MARLTON NJ
08053-3126
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-9400
  • Fax: 609-267-9457
Mailing address:
  • Phone: 609-267-9400
  • Fax: 609-267-9457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01691700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: