Jeanzen Michelle Lintag Raqueno, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

J1-0002167 Issued in DE

Practice address

1078 S State St
Suite 1
Dover, DE 19901-6925

Phone

(302) 678-2397

Fax

(302) 678-2399

NPI assigned

Mar 27, 2008

Last updated

Mar 15, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Jeanzen Michelle Bernabe Lintag Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300147200000",
    "number": "1164694402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 BLUEBALL AVE",
            "city": "LINWOOD",
            "state": "PA",
            "postal_code": "190613922",
            "telephone_number": "610-859-8850",
            "fax_number": "610-672-9936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1078 S STATE ST",
            "address_2": "SUITE 1",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199016925",
            "telephone_number": "302-678-2397",
            "fax_number": "302-678-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAQUENO",
        "first_name": "JEANZEN MICHELLE",
        "middle_name": "LINTAG",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-27",
        "last_updated": "2011-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DE",
            "license": "J1-0002167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164694402",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "295853",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC PERSONAL CHOICE",
            "identifier": "3761297000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12033691",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANZEN MICHELLE",
            "last_name": "LINTAG",
            "middle_name": "BERNABE",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Dover, DE
• Providers in Dover, DE by specialty
• Physical Therapist in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.