MEDICARE: DR. JENNIFER JORDAN LANDER P. T.

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	2251P0200X	Pediatric Physical Therapist
2	2251N0400X	Neurology Physical Therapist	4288	GA
3	225100000X	Physical Therapist	4288	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649225624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER JORDAN LANDER P. T.

Provider Business Mailing Address
First Line	:	PO BOX 39
Second Line	:
City	:	PEMBROKE
State	:	GA
Zip	:	31321-0039
Country	:	US
Telephone Number	:	912-653-4863
Fax Number	:	912-653-7979

Provider Business Practice Location Address
First Line	:	163 WINDING WAY
Second Line	:
City	:	PEMBROKE
State	:	GA
Zip	:	31321-5535
Country	:	US
Telephone Number	:	912-547-0181
Fax Number	:	912-653-7979

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	02/24/2010

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