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General NPI Number Information
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NPI Number | 1033415807
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Entity Type | Individual
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Provider Name | JENNIFER ANN MODZELEWSKI PTA
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Gender | Female
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 4625 BAYSHORE DR APT D16
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City | NAPLES
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State | FL
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Zip | 34112-4360
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Country | US
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Telephone | 586-524-3089
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Fax |
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Provider Business Mailing Address
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Address Line | 978 GIBRALTAR RD UNIT 2
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City | KEY LARGO
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State | FL
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Zip | 33037-4609
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Country | US
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Telephone | 586-524-3089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502002091
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA25476
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License Number State | FL
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