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General NPI Number Information
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NPI Number | 1962528364
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Entity Type | Individual
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Provider Name | JENNIFER LYN SHEAN PTA
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 240 ANN ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5543
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Country | US
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Telephone | 910-484-7660
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Fax |
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Provider Business Mailing Address
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Address Line | 10 NORMANDY DR
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City | FORT BRAGG
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State | NC
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Zip | 28307-3479
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Country | US
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Telephone | 845-537-5719
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3535
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2005037324
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 006135
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License Number State | NY
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