MEDICARE: MRS. JENNIFER A WEAVER-CROOKHAM PT

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	7242	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	066615	OTHER	CO	MEDICARE GROUP #

General Provider Information

NPI Number	:	1447248307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER A WEAVER-CROOKHAM PT

Provider Business Mailing Address
First Line	:	720 S COLORADO BLVD
Second Line	:	SUITE 200-A, DEPT 914
City	:	GLENDALE
State	:	CO
Zip	:	80246-1912
Country	:	US
Telephone Number	:	303-584-8000
Fax Number	:	303-584-8141

Provider Business Practice Location Address
First Line	:	720 S COLORADO BLVD
Second Line	:	SUITE 200-A, DEPT 914
City	:	GLENDALE
State	:	CO
Zip	:	80246-1912
Country	:	US
Telephone Number	:	303-584-8288
Fax Number	:	866-210-2804

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	02/11/2008

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