MEDICARE: MS. JENNIFER MAXEY

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	225200000X	Physical Therapy Assistant	2093741	TX

General Provider Information

NPI Number	:	1033553136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER MAXEY

Provider Business Mailing Address
First Line	:	41207 GLASGOW RD
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-9692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 W SR 436
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2921
Country	:	US
Telephone Number	:	800-226-9917
Fax Number	:

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

Provider Enumeration Date	:	04/20/2013
Last Update Date	:	04/20/2013

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