Provider Demographics
NPI:1487778205
Name:BECKNER, JENNIFER RAE (PTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RAE
Last Name:BECKNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:RAE
Other - Last Name:GULISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2501 COTTONTAIL LANE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:888-873-6493
Mailing Address - Fax:
Practice Address - Street 1:1597 WASHINGTON PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017
Practice Address - Country:US
Practice Address - Phone:412-564-5682
Practice Address - Fax:412-564-5479
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE-005671-L225200000X
PAF03885237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant