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General NPI Number Information
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NPI Number | 1841457934
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Entity Type | Individual
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Provider Name | JENNIFER LYNN SQUIRE DPT
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Gender | Female
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Dates
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Enumeration Date | 05/18/2008
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 4320 196TH ST SW STE A
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City | LYNNWOOD
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State | WA
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Zip | 98036-6753
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Country | US
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Telephone | 425-967-0051
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Fax | 425-967-0053
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Provider Business Mailing Address
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Address Line | 4805 SPRING FLOWER CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-3597
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Country | US
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Telephone | 317-442-8098
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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 | 05009298A
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License Number State | IN
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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 | 60151157
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1193648
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License Number State | TX
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