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1528661048

NPI Code Detail

MEDICARE: JENISE JEAN-GILLES PTA

MEDICARE: JENISE JEAN-GILLES PTA

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	208100000X	Physical Medicine & Rehabilitation Physician	PTA30136	FL

General Provider Information

NPI Number	:	1528661048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENISE JEAN-GILLES PTA

Provider Business Mailing Address
First Line	:	171 NE 209TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-1723
Country	:	US
Telephone Number	:	754-707-2066
Fax Number	:

Provider Business Practice Location Address
First Line	:	2564 W 72ND PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-6507
Country	:	US
Telephone Number	:	786-334-3125
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ JENISE JEAN-GILLES PTA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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