MEDICARE: JESSICA CHERRON NEW 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	314000000X	Skilled Nursing Facility	06003580A	IN

General Provider Information

NPI Number	:	1801100508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CHERRON NEW PTA

Provider Business Mailing Address
First Line	:	2225 N 1000 W
Second Line	:
City	:	PARKER CITY
State	:	IN
Zip	:	47368-9303
Country	:	US
Telephone Number	:	765-625-1628
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 N 1000 W
Second Line	:
City	:	PARKER CITY
State	:	IN
Zip	:	47368-9303
Country	:	US
Telephone Number	:	765-625-1628
Fax Number	:

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

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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