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NPI Code Detail

MEDICARE: JENNIFER JOAN WILEY M.P.T.

MEDICARE: JENNIFER JOAN WILEY M.P.T.
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
1225100000XPhysical Therapist5202CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982780342
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER JOAN WILEY M.P.T.
Provider Business Mailing Address
First Line : 3744 S TIMBERLINE RD
Second Line : SUITE 103
City : FORT COLLINS
State : CO
Zip : 80525-4333
Country : US
Telephone Number : 970-204-4263
Fax Number :
Provider Business Practice Location Address
First Line : 3744 S TIMBERLINE RD
Second Line : SUITE 103
City : FORT COLLINS
State : CO
Zip : 80525-4333
Country : US
Telephone Number : 970-204-4263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2006
Last Update Date : 03/03/2008

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