| Doctor Name: | MRS. JEANZEN MICHELLE LINTAG RAQUENO |
| NPI Number: | 1164694402 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | J1-0002167 |
| Business Practice Address: | 1078 S State St Suite 1 Dover, DE - 199016925 |
| Business Phone Number: | 3026782397 |
| Business Fax Number: | 3026782399 |
| Mailing Address: | 1501 Blueball Ave, LINWOOD |
| State: | PA |
| Postal Code: | 190613922 |
| Phone Number: | 6108598850 |
| Fax Number: | 6106729936 |
| NPI Enumeration Date: | 03/27/2008 |
| NPI Last Update Date: | 03/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | J1-0002167 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DE |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |