MEDICARE: MRS. JENNIE JO MARSHALL MPT

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		IL

General Provider Information

NPI Number	:	1245454909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIE JO MARSHALL MPT

Provider Business Mailing Address
First Line	:	330 N JEFFERSON ST APT 1807
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1214
Country	:	US
Telephone Number	:	847-322-9575
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 N JEFFERSON ST APT 1807
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1214
Country	:	US
Telephone Number	:	847-322-9575
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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