MEDICARE: MRS. JENNIFER MARIE PHILLIPS PTA

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	225200000X	Physical Therapy Assistant	160.000906	IL

General Provider Information

NPI Number	:	1760638621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE PHILLIPS PTA

Provider Business Mailing Address
First Line	:	538 COUNTY ROAD 550 E
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-4049
Country	:	US
Telephone Number	:	217-895-2441
Fax Number	:

Provider Business Practice Location Address
First Line	:	538 COUNTY ROAD 550 E
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-4049
Country	:	US
Telephone Number	:	217-895-2441
Fax Number	:

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/12/2008

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