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NPI Code Detail

MEDICARE: MS. NYAWOH WINNIFRED JENGO PTA

MEDICARE: MS. NYAWOH WINNIFRED JENGO 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 AssistantTE007796PA

General Provider Information

NPI Number : 1124141460
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NYAWOH WINNIFRED JENGO PTA
Provider Business Mailing Address
First Line : 2127 S 58TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19143-5907
Country : US
Telephone Number : 215-727-3578
Fax Number :
Provider Business Practice Location Address
First Line : 2100 W GIRARD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-1400
Country : US
Telephone Number : 215-685-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 07/08/2007

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