MEDICARE: MRS. JENNIFER MAE DEFREZE

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	026835	NY

General Provider Information

NPI Number	:	1396022844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MAE DEFREZE

Provider Business Mailing Address
First Line	:	37 N UNION ST
Second Line	:
City	:	SPENCERPORT
State	:	NY
Zip	:	14559-1244
Country	:	US
Telephone Number	:	585-349-2860
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 N UNION ST
Second Line	:
City	:	SPENCERPORT
State	:	NY
Zip	:	14559-1244
Country	:	US
Telephone Number	:	585-349-2860
Fax Number	:

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

Provider Enumeration Date	:	11/11/2011
Last Update Date	:	11/11/2011

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