=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346602794
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. JENNIFER R HESS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2016
-----------------------------------------------------
Last Update Date | 03/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 709 QUILLEN AVE
-----------------------------------------------------
City | FOUNTAIN INN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29644-9444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-601-1440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 COG HILL DR
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29681-6307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-525-4361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251G0304X
-----------------------------------------------------
Taxonomy Name | Geriatric Physical Therapist
-----------------------------------------------------
License Number | 1476
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------