=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386856706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE FRANCES MENNIE MS,PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2007
-----------------------------------------------------
Last Update Date | 12/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 KINGWOOD DR
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-359-3535
-----------------------------------------------------
Fax | 281-359-1885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 BOYD RIDGE DR
-----------------------------------------------------
City | MURPHY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28906-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-788-0081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1171828
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 10729
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT005262
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------