MEDICARE: JENNIFER CANNARD PT

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	00005652	WA

General Provider Information

NPI Number	:	1588429864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CANNARD PT

Provider Business Mailing Address
First Line	:	3410 SW 108TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-1748
Country	:	US
Telephone Number	:	206-910-7822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 SW 108TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-1748
Country	:	US
Telephone Number	:	206-910-7822
Fax Number	:

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

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	02/16/2024

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