Healthcare Provider Details

I. General information

NPI: 1134983364
Provider Name (Legal Business Name): JENNIFER TEAL DEL ROSSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLD FERN HILL RD
WEST CHESTER PA
19380-4269
US

IV. Provider business mailing address

42 ROSEWOOD LN
MALVERN PA
19355-8618
US

V. Phone/Fax

Practice location:
  • Phone: 610-738-2480
  • Fax:
Mailing address:
  • Phone: 484-678-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT012684L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: