Healthcare Provider Details

I. General information

NPI: 1972262434
Provider Name (Legal Business Name): DR. JEN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAIN ST STE 1C
WAKEFIELD RI
02879-3550
US

IV. Provider business mailing address

46 LEGEND ROCK RD
WAKEFIELD RI
02879-2071
US

V. Phone/Fax

Practice location:
  • Phone: 401-218-0885
  • Fax: 401-574-2034
Mailing address:
  • Phone: 401-339-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER L SANT
Title or Position: OWNER
Credential:
Phone: 401-339-8367