Healthcare Provider Details

I. General information

NPI: 1083656185
Provider Name (Legal Business Name): JENNIFER LYNN KOTLARCZYK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN BENSON PT

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 UNIVERSITY PKWY
SARASOTA FL
34243-2502
US

IV. Provider business mailing address

7216 US HIGHWAY 301 N SUITE 115
ELLENTON FL
34222-3462
US

V. Phone/Fax

Practice location:
  • Phone: 941-359-8233
  • Fax: 941-359-8255
Mailing address:
  • Phone: 941-729-0003
  • Fax: 941-729-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: