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NPI Code Detail

MEDICARE: JENNIFER R DIEHL

MEDICARE: JENNIFER R DIEHL
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
1225200000XPhysical Therapy AssistantPTA28927FL

General Provider Information

NPI Number : 1336610625
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER R DIEHL
Provider Business Mailing Address
First Line : 5312 17TH AVE S
Second Line :
City : GULFPORT
State : FL
Zip : 33707-4211
Country : US
Telephone Number : 727-599-7797
Fax Number :
Provider Business Practice Location Address
First Line : 515 CHESAPEAKE DR
Second Line :
City : TARPON SPRINGS
State : FL
Zip : 34689-2515
Country : US
Telephone Number : 727-934-4629
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2018
Last Update Date : 12/11/2018

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Directions to “ JENNIFER R DIEHL ” Practice Location

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