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General NPI Number Information
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NPI Number | 1104085489
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Entity Type | Individual
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Provider Name | JENNIFER METTILLE
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Gender | Female
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 261 CONNECTICUT DR SUITE 5
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City | BURLINGTON
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State | NJ
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Zip | 08016-4177
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Country | US
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Telephone | 800-950-6066
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 544
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City | POMONA
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State | NJ
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Zip | 08240-0544
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Country | US
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Telephone | 800-950-6066
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00090600
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License Number State | NJ
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