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NPI Code Detail

MEDICARE: JENNIFER REXON DPT

MEDICARE: JENNIFER REXON 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
1225100000XPhysical Therapist40QA01283900NJ

General Provider Information

NPI Number : 1174789697
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER REXON DPT
Provider Business Mailing Address
First Line : 200 EVERGREEN DR
Second Line :
City : MOORESTOWN
State : NJ
Zip : 08057-2310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 132 W MAIN ST
Second Line :
City : MOORESTOWN
State : NJ
Zip : 08057-2432
Country : US
Telephone Number : 856-234-4397
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2008
Last Update Date : 08/04/2008

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