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NPI Code Detail

MEDICARE: MRS. JENNIFER MARIE PITLICK DPT

MEDICARE: MRS. JENNIFER MARIE PITLICK DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist004245IA

General Provider Information

NPI Number : 1013244300
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER MARIE PITLICK DPT
Provider Business Mailing Address
First Line : 415 SE CARDINAL LN
Second Line :
City : WAUKEE
State : IA
Zip : 50263-9681
Country : US
Telephone Number : 319-404-0972
Fax Number :
Provider Business Practice Location Address
First Line : 3200 WESTOWN PKWY
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-1110
Country : US
Telephone Number : 515-266-1212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2009
Last Update Date : 05/30/2013

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