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General NPI Number Information
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NPI Number | 1689960015
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Entity Type | Individual
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Provider Name | JENNIFER ELIZABETH HOCTOR PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 1201 SILOAM RD
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City | GREENSBORO
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State | GA
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Zip | 30642-2811
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Country | US
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Telephone | 706-453-5088
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 PARK AVE. BLDG. D STE. 100
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City | PARK CITY
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State | UT
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Zip | 84060
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Country | US
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Telephone | 435-615-8822
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Fax | 435-615-8822
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PTL-11239
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT011057
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License Number State | GA
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