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NPI Code Detail

MEDICARE: JENNIFER TESLEVICH

MEDICARE: JENNIFER TESLEVICH
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 Therapist13024AZ

General Provider Information

NPI Number : 1437687878
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER TESLEVICH
Provider Business Mailing Address
First Line : 6122 N 18TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-2052
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4455 E CAMELBACK RD STE D155
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-2888
Country : US
Telephone Number : 602-808-8989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2017
Last Update Date : 05/30/2017

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