MEDICARE: MRS. JENNIFER MARY CORCORAN PT

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	7000	AZ

General Provider Information

NPI Number	:	1558403436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARY CORCORAN PT

Provider Business Mailing Address
First Line	:	7575 E INDIAN BEND RD
Second Line	:	#1101
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-4660
Country	:	US
Telephone Number	:	608-780-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 E INDIAN BEND RD
Second Line	:	#1101
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-4660
Country	:	US
Telephone Number	:	608-780-0113
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	06/06/2011

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