MEDICARE: JENNIFER CAMMACK 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	225100000X	Physical Therapist	102529882401	UT

General Provider Information

NPI Number	:	1851832620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CAMMACK DPT

Provider Business Mailing Address
First Line	:	7392 S 1975 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-3249
Country	:	US
Telephone Number	:	385-275-5689
Fax Number	:

Provider Business Practice Location Address
First Line	:	7392 S 1975 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-3249
Country	:	US
Telephone Number	:	385-275-5689
Fax Number	:

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

Provider Enumeration Date	:	03/14/2017
Last Update Date	:	12/21/2022

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