MEDICARE: JENNIFER PAUL DPT

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	208100000X	Physical Medicine & Rehabilitation Physician	PTT32539	FL
2	225100000X	Physical Therapist	PT32539	FL

General Provider Information

NPI Number	:	1700315736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PAUL DPT

Provider Business Mailing Address
First Line	:	1245 NORTHERN WAY
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 E STATE ROAD 434 STE 2001B
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-2744
Country	:	US
Telephone Number	:	407-542-1224
Fax Number	:	407-542-1155

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

Provider Enumeration Date	:	06/04/2017
Last Update Date	:	10/25/2022

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