Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA00805500 | NJ |
N | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1194849786 |
---|---|
Provider Name | Mrs. Jennifer Martino |
First Address | Egg Harbor City, NJ 08215-4157 |
Second Address | Egg Harbor City, NJ 08215-4157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 02/07/2020 |