MEDICARE: DR. JEN LE COGUIC, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1538839667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JEN LE COGUIC, LLC

Provider Business Mailing Address
First Line	:	262 SUNRISE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-2904
Country	:	US
Telephone Number	:	615-498-0410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 BERRY HILL DR UNIT A
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3126
Country	:	US
Telephone Number	:	615-498-0410
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER LE COGUIC
Credential	:	PT, DPT, OCS
Telephone Number	:	615-498-0410

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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