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NPI Code Detail

MEDICARE: JENNIFER GAYNOR PT, DPT

MEDICARE: JENNIFER GAYNOR PT, 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 Therapist13245-24WI

General Provider Information

NPI Number : 1619347119
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GAYNOR PT, DPT
Provider Business Mailing Address
First Line : 7550 34TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55450-1124
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7550 34TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55450-1124
Country : US
Telephone Number : 612-727-1167
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2015
Last Update Date : 09/28/2015

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