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General NPI Number Information
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NPI Number | 1720260904
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Entity Type | Organization
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Legal Business Name | JENNY ROSE SPECIALIZED THERAPY CENTER LLC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 296 E BROWN ST SUITE B
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3011
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Country | US
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Telephone | 570-421-3415
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Fax | 570-421-9873
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Provider Business Mailing Address
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Address Line | 296 E BROWN ST SUITE B
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3011
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Country | US
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Telephone | 570-421-3415
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Fax | 570-421-9873
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | ELAINE R PARKER
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Credential | CHT
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Telephone | 570-421-3415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC005819
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License Number State | PA
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