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General NPI Number Information
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NPI Number | 1104410653
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Entity Type | Individual
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Provider Name | JENNISE MORIN DPT
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Gender | Female
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Dates
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Enumeration Date | 02/25/2021
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 718 22ND AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33705-3004
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Country | US
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Telephone | 727-894-5152
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Fax |
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Provider Business Mailing Address
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Address Line | 7892 SAILBOAT KEY BLVD S UNIT 601
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-6363
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Country | US
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Telephone | 774-254-5993
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT36766
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License Number State | MA
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