Provider Demographics
NPI:1437528544
Name:DEMARCO, JENNIFER C (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SIR TYLER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-8305
Mailing Address - Country:US
Mailing Address - Phone:910-782-2150
Mailing Address - Fax:
Practice Address - Street 1:1800 SIR TYLER DR STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-8305
Practice Address - Country:US
Practice Address - Phone:910-782-2150
Practice Address - Fax:773-774-4527
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist