MEDICARE: MRS. JENNY JULE VAN METER ATC

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	2255A2300X	Athletic Trainer		CO

General Provider Information

NPI Number	:	1700853413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY JULE VAN METER ATC

Provider Business Mailing Address
First Line	:	632 E 130TH CT
Second Line	:
City	:	THORNTON
State	:	CO
Zip	:	80241-1711
Country	:	US
Telephone Number	:	720-872-8121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4276 W 68TH AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80030-5832
Country	:	US
Telephone Number	:	303-428-9541
Fax Number	:

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/08/2007

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