Basic Information
| Provider Information | |||||||||
| NPI: | 1013085315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOARES | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT, DPT, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074171368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018478585 | ||||||||
| FaxNumber: | 2018470985 | ||||||||
| Practice Location | |||||||||
| Address1: | 795 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074171368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018478585 | ||||||||
| FaxNumber: | 2018470985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | QA00873100 | NJ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.