MEDICARE: JENNIFER LYN HAWLEY 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
1	225100000X	Physical Therapist	2305204403	VA

General Provider Information

NPI Number	:	1376632653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYN HAWLEY DPT

Provider Business Mailing Address
First Line	:	611 FERN MEADOW LOOP APT 207
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-4627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 POLO PKWY
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-1453
Country	:	US
Telephone Number	:	804-323-9060
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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