MEDICARE: JENNIFER CERMENARO PT, 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		VT

General Provider Information

NPI Number	:	1871169268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CERMENARO PT, DPT

Provider Business Mailing Address
First Line	:	373 BLAIR PARK ROAD
Second Line	:	SUITE 204
City	:	WILLISTON
State	:	VT
Zip	:	05495-8056
Country	:	US
Telephone Number	:	802-662-4672
Fax Number	:	802-662-5964

Provider Business Practice Location Address
First Line	:	373 BLAIR PARK ROAD
Second Line	:	SUITE 204
City	:	WILLISTON
State	:	VT
Zip	:	05495-8056
Country	:	US
Telephone Number	:	802-662-4672
Fax Number	:	802-662-5964

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	03/06/2023

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