Healthcare Provider Details

I. General information

NPI: 1972808574
Provider Name (Legal Business Name): JENNIFER MURNIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 HOUSTON AVENUE
MCALLEN TX
78501
US

IV. Provider business mailing address

PO BOX 43
RIO NIDO CA
95471
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-6331
  • Fax:
Mailing address:
  • Phone: 415-272-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2080109
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: