Healthcare Provider Details

I. General information

NPI: 1265504450
Provider Name (Legal Business Name): JENNIFER SKULY MEADOWS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNN SKULY

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 59TH ST W
BRADENTON FL
34209-4604
US

IV. Provider business mailing address

14818 7TH AVE E
BRADENTON FL
34212-2902
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-6180
  • Fax:
Mailing address:
  • Phone: 941-993-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19862
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9323
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT19862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: