MEDICARE: MRS. JENNIFER LEE IANNUCCI 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	2251X0800X	Orthopedic Physical Therapist	005735	CT

General Provider Information

NPI Number	:	1831128834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LEE IANNUCCI PT

Provider Business Mailing Address
First Line	:	46 DRIFTWOOD LN
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1861
Country	:	US
Telephone Number	:	203-880-5221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2889 FAIRFIELD AVENUE
Second Line	:
City	:	BRIDEGPORT
State	:	CT
Zip	:	06606-1744
Country	:	US
Telephone Number	:	203-913-6978
Fax Number	:

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	02/18/2013

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