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General NPI Number Information
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NPI Number | 1649348657
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Entity Type | Individual
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Provider Name | JENNIFER MARIE ROOS MPT
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6335 N FRESNO ST STE 108
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City | FRESNO
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State | CA
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Zip | 93710-5272
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Country | US
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Telephone | 559-435-6735
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Fax | 559-435-5793
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Provider Business Mailing Address
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Address Line | 307 MOODY AVE
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City | CLOVIS
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State | CA
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Zip | 93619-7555
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Country | US
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Telephone | 559-297-8103
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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 | PT26084
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License Number State | CA
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