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NPI Code Detail

MEDICARE: JENNIFER ELAINE SORRELL PT, CLT

MEDICARE: JENNIFER ELAINE SORRELL PT, CLT
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
1225100000XPhysical TherapistPT22923FL

General Provider Information

NPI Number : 1558691865
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ELAINE SORRELL PT, CLT
Provider Business Mailing Address
First Line : 807 N TYNDALL PKWY
Second Line :
City : CALLAWAY
State : FL
Zip : 32404-9495
Country : US
Telephone Number : 850-763-0505
Fax Number :
Provider Business Practice Location Address
First Line : 807 N TYNDALL PKWY
Second Line :
City : CALLAWAY
State : FL
Zip : 32404-9495
Country : US
Telephone Number : 850-763-0505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2010
Last Update Date : 01/08/2010

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