Healthcare Provider Details

I. General information

NPI: 1093024002
Provider Name (Legal Business Name): JENNIFER JANE ZOLL MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2010
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5417 ALTAMESA BLVD
FORT WORTH TX
76123-2804
US

IV. Provider business mailing address

4716 TEAROSE TRL
FORT WORTH TX
76123-1817
US

V. Phone/Fax

Practice location:
  • Phone: 817-292-2886
  • Fax:
Mailing address:
  • Phone: 817-386-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1161850
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1161850
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: