MEDICARE: MRS. JENNIFER GWEN BEAL P.T.

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	PT 4764	FL

General Provider Information

NPI Number	:	1396825774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER GWEN BEAL P.T.

Provider Business Mailing Address
First Line	:	6461 SPARTINA CIR
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-1811
Country	:	US
Telephone Number	:	561-747-5184
Fax Number	:	561-747-5184

Provider Business Practice Location Address
First Line	:	2505 METROCENTRE BLVD
Second Line	:	SUITE 201
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3114
Country	:	US
Telephone Number	:	561-688-1844
Fax Number	:	561-688-1845

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/09/2007

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