MEDICARE: SARAH ELIZABETH JENNISON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	19512	CO

General Provider Information

NPI Number	:	1023883725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH JENNISON DPT

Provider Business Mailing Address
First Line	:	1268 INTERQUEST PKWY STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-4209
Country	:	US
Telephone Number	:	719-418-7610
Fax Number	:	719-203-6542

Provider Business Practice Location Address
First Line	:	1268 INTERQUEST PKWY STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-4209
Country	:	US
Telephone Number	:	719-418-7610
Fax Number	:	719-203-6542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2023
Last Update Date	:	11/22/2023

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