MEDICARE: DR. ADAM JEANFREAU PT, 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

General Provider Information

NPI Number	:	1528539905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM JEANFREAU PT, DPT

Provider Business Mailing Address
First Line	:	8252 PERSIA WAY
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-7077
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11316 LEBANON RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-5504
Country	:	US
Telephone Number	:	601-573-4834
Fax Number	:

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

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	04/06/2023

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