MEDICARE: JENSYNN ELIZABETH DECKARD 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	11-06759	KS
2	225100000X	Physical Therapist	2021026426	MO

General Provider Information

NPI Number	:	1972184851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENSYNN ELIZABETH DECKARD PT, DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	10801 E STATE ROUTE 350 STE B
Second Line	:
City	:	RAYTOWN
State	:	MO
Zip	:	64138-2384
Country	:	US
Telephone Number	:	816-737-5502
Fax Number	:	816-737-5504

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	07/12/2021

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