Provider Demographics
NPI:1043678980
Name:STUEBE, JENNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:STUEBE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DOROTOCKEYS LN
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7344
Mailing Address - Country:US
Mailing Address - Phone:201-206-3196
Mailing Address - Fax:
Practice Address - Street 1:11 DOROTOCKEYS LN
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7344
Practice Address - Country:US
Practice Address - Phone:201-206-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22140225100000X
NJ40QA01435900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist