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NPI Code Detail

MEDICARE: DR. JENNIFER LINDSAY ROME DPT

MEDICARE:  DR. JENNIFER LINDSAY ROME  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 Therapist5501013716MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P55360008OTHERMIMEDICARE PTAN

General Provider Information

NPI Number : 1255571287
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER LINDSAY ROME DPT
Provider Business Mailing Address
First Line : 205 W WACKER DR
Second Line : SUITE 1020
City : CHICAGO
State : IL
Zip : 60606-1216
Country : US
Telephone Number : 312-640-0329
Fax Number : 312-640-0407
Provider Business Practice Location Address
First Line : 29480 WOODWARD AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-0903
Country : US
Telephone Number : 248-541-9121
Fax Number : 248-541-8386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2009
Last Update Date : 04/23/2014

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