Provider Demographics
NPI:1871789537
Name:PITASSI, JENNIFER VANDAL (PT, PCS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:VANDAL
Last Name:PITASSI
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Gender:F
Credentials:PT, PCS
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Mailing Address - Street 1:169 ASHLEY AVE RM 398 3 SW
Mailing Address - Street 2:PO BOX 250350
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-792-3481
Mailing Address - Fax:843-792-0724
Practice Address - Street 1:169 ASHLEY AVE RM 398 3 SW
Practice Address - Street 2:PHYSICAL THERAPY DEPT
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:843-792-3481
Practice Address - Fax:843-792-0724
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC19912251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics