MEDICARE: MS. JENNIFER SY RPT

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	PT23156	FL

General Provider Information

NPI Number	:	1720126360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER SY RPT

Provider Business Mailing Address
First Line	:	1810 SE 14TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-6822
Country	:	US
Telephone Number	:	239-574-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	3046 DEL PRADO BLVD S
Second Line	:	STE 2-A
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7221
Country	:	US
Telephone Number	:	239-549-5585
Fax Number	:

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

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	07/08/2007

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