Provider Demographics
NPI:1366276164
Name:EXCELLENT, JEANISHKA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEANISHKA
Middle Name:
Last Name:EXCELLENT
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 CADILLAC RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4816
Mailing Address - Country:US
Mailing Address - Phone:609-880-0880
Mailing Address - Fax:
Practice Address - Street 1:11 CADILLAC RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4816
Practice Address - Country:US
Practice Address - Phone:609-880-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic