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NPI Code Detail

MEDICARE: MRS. JENNIFER LEIGH LIEBERMAN M.S.P.T.

MEDICARE: MRS. JENNIFER LEIGH LIEBERMAN M.S.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
1225100000XPhysical TherapistPT012848LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LI1490266OTHERPAHIGHMARK BLUE SHIELD #
2PT012848LOTHERPAPT LICENSE #

General Provider Information

NPI Number : 1457472243
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER LEIGH LIEBERMAN M.S.P.T.
Provider Business Mailing Address
First Line : 112 S 20TH ST
Second Line :
City : POTTSVILLE
State : PA
Zip : 17901-3203
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 SETON DR
Second Line :
City : ORWIGSBURG
State : PA
Zip : 17961-1009
Country : US
Telephone Number : 570-366-1941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 07/08/2007

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