MEDICARE: JENNIFER MILLER P.T.

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	1166953	TX

General Provider Information

NPI Number	:	1104967322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MILLER P.T.

Provider Business Mailing Address
First Line	:	5411 BASSWOOD BLVD
Second Line	:	SUITE 225
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4477
Country	:	US
Telephone Number	:	817-498-0700
Fax Number	:	817-498-0813

Provider Business Practice Location Address
First Line	:	5411 BASSWOOD BLVD
Second Line	:	SUITE 225
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4477
Country	:	US
Telephone Number	:	817-498-0700
Fax Number	:	817-498-0813

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	06/08/2011

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