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General NPI Number Information
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NPI Number | 1619199080
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Entity Type | Individual
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Provider Name | JENNIFER LONG MPT
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 4146 LIBRARY RD SUITE E
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City | PITTSBURGH
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State | PA
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Zip | 15234-1350
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Country | US
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Telephone | 412-833-6663
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Fax |
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Provider Business Mailing Address
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Address Line | 4119 GEORGIA ST NW
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City | MASSILLON
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State | OH
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Zip | 44646-3266
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Country | US
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Telephone | 330-639-3191
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT011186L
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License Number State | PA
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