=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285026054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEN NAYLOR PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2015
-----------------------------------------------------
Last Update Date | 03/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 975 E 3RD ST
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37403-2147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-778-7916
-----------------------------------------------------
Fax | 423-778-6721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3720 OWEDA TER
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37415-4021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-778-7043
-----------------------------------------------------
Fax | 423-778-6721
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 0000001346
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------