MEDICARE: JENNIFER LYNNE FORD P.T.

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	2251G0304X	Geriatric Physical Therapist	070.010806	IL
2	2251N0400X	Neurology Physical Therapist	070.010806	IL

General Provider Information

NPI Number	:	1538479712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNNE FORD P.T.

Provider Business Mailing Address
First Line	:	106 W WHITE OAK ST
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3135
Country	:	US
Telephone Number	:	847-952-8109
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 W WHITE OAK ST
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3135
Country	:	US
Telephone Number	:	847-952-8109
Fax Number	:

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

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	10/20/2010

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