Healthcare Provider Details

I. General information

NPI: 1700884632
Provider Name (Legal Business Name): JENNIFER AMY KILGAS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRAC REHAB EAST 4403 IROGUOIS AVE
ERIE PA
16511
US

IV. Provider business mailing address

TRAC REHAB EAST 4403 IROGUOIS AVE
ERIE PA
16511
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-7078
  • Fax: 814-899-5484
Mailing address:
  • Phone: 814-877-7078
  • Fax: 814-899-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015045
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: