MEDICARE: JENNIFER A MOGAVERO 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	1256	NV
2	225100000X	Physical Therapist	8861	CO
3	225100000X	Physical Therapist	016958-1	NY

General Provider Information

NPI Number	:	1669655205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A MOGAVERO PT

Provider Business Mailing Address
First Line	:	3228 IVORY COAST DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2269
Country	:	US
Telephone Number	:	702-236-9454
Fax Number	:

Provider Business Practice Location Address
First Line	:	3228 IVORY COAST DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2269
Country	:	US
Telephone Number	:	702-236-9454
Fax Number	:

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

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	05/26/2009

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Directions to “ JENNIFER A MOGAVERO PT” Practice Location

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