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NPI Code Detail

MEDICARE: JENNIFER ANN BEIDECK PTA

MEDICARE: JENNIFER ANN BEIDECK 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 Assistant003691-1NY

General Provider Information

NPI Number : 1134379639
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN BEIDECK PTA
Provider Business Mailing Address
First Line : 41 COLEBROOK DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-2211
Country : US
Telephone Number : 585-467-4567
Fax Number :
Provider Business Practice Location Address
First Line : 41 COLEBROOK DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-2211
Country : US
Telephone Number : 585-467-4567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2008
Last Update Date : 09/22/2008

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Directions to “ JENNIFER ANN BEIDECK PTA” Practice Location

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