MEDICARE: MRS. JESSICA D CHANEY 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	2010022729	MO

General Provider Information

NPI Number	:	1922310820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA D CHANEY DPT

Provider Business Mailing Address
First Line	:	303 N KEENE ST
Second Line	:	SUITE 102
City	:	COLUMBIA
State	:	MO
Zip	:	65201-7193
Country	:	US
Telephone Number	:	573-443-0225
Fax Number	:	573-443-0290

Provider Business Practice Location Address
First Line	:	5780 OSAGE BEACH PKWY
Second Line	:	SUITE 220
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3188
Country	:	US
Telephone Number	:	573-693-9128
Fax Number	:	573-693-9136

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	03/09/2016

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