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NPI Code Detail

MEDICARE: JENNIFER DOLTON PTA

MEDICARE: JENNIFER DOLTON PTA
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
1225200000XPhysical Therapy AssistantTX

General Provider Information

NPI Number : 1114407988
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER DOLTON PTA
Provider Business Mailing Address
First Line : 10301 RR 2222 APT 331
Second Line :
City : AUSTIN
State : TX
Zip : 78730-1208
Country : US
Telephone Number : 512-636-6848
Fax Number :
Provider Business Practice Location Address
First Line : 4501 DUDMAR DR
Second Line :
City : AUSTIN
State : TX
Zip : 78735-6913
Country : US
Telephone Number : 512-892-1131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2018
Last Update Date : 08/20/2018

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Directions to “ JENNIFER DOLTON PTA” Practice Location

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