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General NPI Number Information
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NPI Number | 1396957338
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Entity Type | Individual
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Provider Name | JENNIFER JOSEPH PTA
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1191 EAST NEWPORT CENTER DRIVE SUITE PH-J
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442
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Country | US
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Telephone | 954-379-1066
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Fax |
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Provider Business Mailing Address
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Address Line | 411 NW 101ST AVE
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-6841
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Country | US
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Telephone | 567-716-6604
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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 | PTA20021
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License Number State | FL
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