MEDICARE: JENNIFER DAWN HALBERG 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	3894	OK

General Provider Information

NPI Number	:	1467566935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DAWN HALBERG PT

Provider Business Mailing Address
First Line	:	3545 NW 58TH ST
Second Line	:	SUITE 940E
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4726
Country	:	US
Telephone Number	:	405-605-1130
Fax Number	:	405-605-1402

Provider Business Practice Location Address
First Line	:	3545 NW 58TH ST
Second Line	:	SUITE 940E
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4726
Country	:	US
Telephone Number	:	405-605-1130
Fax Number	:	405-604-1402

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/08/2011

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