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NPI Code Detail

MEDICARE: MISS JILL ELIZABETH FENNELLY PT

MEDICARE: MISS JILL ELIZABETH FENNELLY PT
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
12251G0304XGeriatric Physical TherapistPT015306PA

General Provider Information

NPI Number : 1184749608
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JILL ELIZABETH FENNELLY PT
Provider Business Mailing Address
First Line : 583 GREEN LN
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2620
Country : US
Telephone Number : 610-888-9684
Fax Number :
Provider Business Practice Location Address
First Line : 1104 WELSH RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-3730
Country : US
Telephone Number : 215-676-9191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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