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NPI Code Detail

MEDICARE: MRS. JENNIFER DUPAN PT

MEDICARE: MRS. JENNIFER DUPAN 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
12251P0200XPediatric Physical TherapistPT008768OH

General Provider Information

NPI Number : 1598796260
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER DUPAN PT
Provider Business Mailing Address
First Line : 27855 TINKERS VALLEY DR
Second Line :
City : SOLON
State : OH
Zip : 44139-2161
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9772 DIAGONAL RD
Second Line :
City : MANTUA
State : OH
Zip : 44255-9128
Country : US
Telephone Number : 330-274-2272
Fax Number : 330-274-3140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 07/08/2007

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