MEDICARE: MR. JARED TENNEY PT, MPT

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	5064	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1Z6798	OTHER	AZ	HEALTH NET
5	64-00187	OTHER	AZ	UNITED HEALTH PLAN

General Provider Information

NPI Number	:	1255334694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARED TENNEY PT, MPT

Provider Business Mailing Address
First Line	:	903 E STATE HIGHWAY 260
Second Line	:	STE 1
City	:	PAYSON
State	:	AZ
Zip	:	85541-4972
Country	:	US
Telephone Number	:	928-474-0429
Fax Number	:	928-474-0199

Provider Business Practice Location Address
First Line	:	903 E STATE HIGHWAY 260
Second Line	:	STE 1
City	:	PAYSON
State	:	AZ
Zip	:	85541-4972
Country	:	US
Telephone Number	:	928-474-0429
Fax Number	:	928-474-0199

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/09/2007

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