MEDICARE: MRS. JENNIFER MARTINO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00805500	NJ
2	2251G0304X	Geriatric Physical Therapist

General Provider Information

NPI Number	:	1194849786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARTINO PT

Provider Business Mailing Address
First Line	:	1396 WHITE OAK CIR
Second Line	:
City	:	EGG HARBOR CITY
State	:	NJ
Zip	:	08215-4157
Country	:	US
Telephone Number	:	609-804-0197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1396 WHITE OAK CIR
Second Line	:
City	:	EGG HARBOR CITY
State	:	NJ
Zip	:	08215-4157
Country	:	US
Telephone Number	:	609-814-0197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/02/2020

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