MEDICARE: JENNIFER ANGELA EAGLES MPT

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
1	225100000X	Physical Therapist	1399	ND
2	225100000X	Physical Therapist	7854	MN
3	225100000X	Physical Therapist	5781	OR
4	225100000X	Physical Therapist	PT 60124585	WA
5	225100000X	Physical Therapist	1210320	TX
6	225100000X	Physical Therapist	9758	AZ

General Provider Information

NPI Number	:	1083752836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANGELA EAGLES MPT

Provider Business Mailing Address
First Line	:	3403 E MAIN ST
Second Line	:	SPACE 2415
City	:	MESA
State	:	AZ
Zip	:	85213-8683
Country	:	US
Telephone Number	:	971-285-6292
Fax Number	:

Provider Business Practice Location Address
First Line	:	12124 HIGH TECH AVE
Second Line	:	STE 300
City	:	ORLANDO
State	:	FL
Zip	:	32817-8373
Country	:	US
Telephone Number	:	800-774-7785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	10/05/2012

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