MEDICARE: JENNIFER CROSS

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1619113826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CROSS

Provider Business Mailing Address
First Line	:	4154 SHADE TREE LANE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5251 LONG LAKE CIR
Second Line	:	203
City	:	LAKELAND
State	:	FL
Zip	:	33805-9609
Country	:	US
Telephone Number	:	813-371-3417
Fax Number	:

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

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	09/06/2013

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Directions to “ JENNIFER CROSS ” Practice Location

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