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NPI Code Detail

MEDICARE: JENNIFER TAYLOR DPT

MEDICARE: JENNIFER TAYLOR DPT
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 Therapist14254WI
2225100000XPhysical Therapist37597CA

General Provider Information

NPI Number : 1578813234
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER TAYLOR DPT
Provider Business Mailing Address
First Line : 17700 W CAPITOL DR
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-2006
Country : US
Telephone Number : 262-781-3083
Fax Number : 262-781-3080
Provider Business Practice Location Address
First Line : 17700 W CAPITOL DR
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-2006
Country : US
Telephone Number : 262-781-3083
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2012
Last Update Date : 02/26/2020

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