MEDICARE: MRS. JENNIFER LYNN SAUDER 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	PT013068L	PA

General Provider Information

NPI Number	:	1730156449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN SAUDER PT

Provider Business Mailing Address
First Line	:	304 CHERRY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-1804
Country	:	US
Telephone Number	:	215-923-8731
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 PENNSYLVANIA AVE
Second Line	:	SUITE 1D5
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3010
Country	:	US
Telephone Number	:	215-236-3700
Fax Number	:	215-236-3466

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/08/2007

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