Provider Demographics
NPI:1770632242
Name:MARYNIAK, JENNIFER (ATC, MED, CSCS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MARYNIAK
Suffix:
Gender:F
Credentials:ATC, MED, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MUSKET LN
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-9541
Mailing Address - Country:US
Mailing Address - Phone:610-921-8078
Mailing Address - Fax:610-921-7922
Practice Address - Street 1:SHARP & FRANCIS STREETS
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605
Practice Address - Country:US
Practice Address - Phone:610-921-8078
Practice Address - Fax:610-921-7922
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001529A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer