Provider Demographics
NPI:1023656477
Name:PERRECA, JENNIFER ROSE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:PERRECA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:GAROFALO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:301 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-2515
Mailing Address - Country:US
Mailing Address - Phone:914-827-9070
Mailing Address - Fax:
Practice Address - Street 1:420 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-3055
Practice Address - Country:US
Practice Address - Phone:914-827-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist