=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992921050
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN JANNETTE R PEPITO PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 PARR AVE.
-----------------------------------------------------
City | DYERSBURG
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-286-1221
-----------------------------------------------------
Fax | 731-285-3886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2311 FAIRFIELD DR
-----------------------------------------------------
City | DYERSBURG
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-334-1489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 3327
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------