Basic Information
Provider Information
NPI: 1063410835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ELWOOD
FirstName: JENNIFER
MiddleName: H.
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Practice Location
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Other Information
ProviderEnumerationDate: 07/14/2005
LastUpdateDate: 01/11/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT010979LPAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
217056301 MAMSIOTHER
96171201 FIRST PRIORITY LIFE INS.OTHER
042373700001 AMERIHEALTHOTHER
042373700001 KEYSTONE HEALTH EASTOTHER
96171201 HIGHMARK BLUE SHIELDOTHER
0316990101 KEYSTONE HEALTH CENTRALOTHER
32898301 HEALTHAMERICA/HEALTHASSUROTHER
P69361501 OXFORD HEALTH PLANSOTHER
0316990101 CAPITAL BLUE CROSSOTHER
215828201 UNITED HEALTHCAREOTHER
578336101 CIGNA HEALTHCAREOTHER
85925701 AETNA PPOOTHER
042373700001 INDEPENDENCE BLUE CROSSOTHER
80659601 FIRST PRIORITY HEALTHOTHER


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