MEDICARE: JENNISE MORIN 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
1	225100000X	Physical Therapist	PT36766	MA

General Provider Information

NPI Number	:	1104410653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNISE MORIN DPT

Provider Business Mailing Address
First Line	:	7892 SAILBOAT KEY BLVD S UNIT 601
Second Line	:
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-6363
Country	:	US
Telephone Number	:	774-254-5993
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 22ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-3004
Country	:	US
Telephone Number	:	727-894-5152
Fax Number	:

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

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/25/2021

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