MEDICARE: JENNIFER A CHAPMAN 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	05007066A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	292775	OTHER	IN	BCBS PIN #

General Provider Information

NPI Number	:	1184687998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A CHAPMAN P.T.

Provider Business Mailing Address
First Line	:	829 WILLEN LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818
Country	:	US
Telephone Number	:	260-432-5404
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 LAKE AVE
Second Line	:	SUITE 24
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5428
Country	:	US
Telephone Number	:	260-424-8830
Fax Number	:	260-424-8868

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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