MEDICARE: JENNIFER PARLOW PTA

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	2522-19	WI

General Provider Information

NPI Number	:	1669923272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PARLOW PTA

Provider Business Mailing Address
First Line	:	3505 COUNTY ROAD Y
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53083-2400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 COUNTY ROAD Y
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53083-2400
Country	:	US
Telephone Number	:	920-458-2137
Fax Number	:

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

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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Directions to “ JENNIFER PARLOW PTA” Practice Location

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