Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT023884 | PA |
NPI | 1548878580 |
---|---|
Provider Name | Dr. Jaclyn Grenier |
First Address | Springfield, PA 19064-3829 |
Second Address | Malvern, PA 19355-3311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2020 |
Last Update Date | 15/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT023884 | PT LICENSE (01) | PA |