Provider Demographics
NPI:1871169268
Name:CERMENARO, JENNIFER (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CERMENARO
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 1:373 BLAIR PARK ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8056
Mailing Address - Country:US
Mailing Address - Phone:802-662-4672
Mailing Address - Fax:802-662-5964
Practice Address - Street 1:373 BLAIR PARK ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8056
Practice Address - Country:US
Practice Address - Phone:802-662-4672
Practice Address - Fax:802-662-5964
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist