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General NPI Number Information
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NPI Number | 1417002866
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Entity Type | Individual
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Provider Name | JENNIFER LYNN MOORE P.T.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15000 MINNETONKA BLVD
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City | MINNETONKA
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State | MN
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Zip | 55345-1506
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Country | US
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Telephone | 952-935-4037
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 HUMBOLDT AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-3329
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Country | US
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Telephone | 612-750-1870
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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 | 2868
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License Number State | MN
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