MEDICARE: JENNIFER KORDSMEIER

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	4561	AR

General Provider Information

NPI Number	:	1558845925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KORDSMEIER

Provider Business Mailing Address
First Line	:	1414 W MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 HARRIS RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3611
Country	:	US
Telephone Number	:	501-982-7456
Fax Number	:

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

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