MEDICARE: JENNIFER AMY KILGAS PT

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	225100000X	Physical Therapist	PT015045	PA

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	:	1700884632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER AMY KILGAS PT

Provider Business Mailing Address
First Line	:	TRAC REHAB EAST
Second Line	:	4403 IROGUOIS AVE
City	:	ERIE
State	:	PA
Zip	:	16511
Country	:	US
Telephone Number	:	814-877-7078
Fax Number	:	814-899-5484

Provider Business Practice Location Address
First Line	:	TRAC REHAB EAST
Second Line	:	4403 IROGUOIS AVE
City	:	ERIE
State	:	PA
Zip	:	16511
Country	:	US
Telephone Number	:	814-877-7078
Fax Number	:	814-899-5484

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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