Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT009685L | PA |
NPI | 1003273285 |
---|---|
Provider Name | Jennifer Dekerlegand |
First Address | Cherry Hill, NJ 08003-2231 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2016 |
Last Update Date | 20/01/2016 |