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NPI Code Detail

MEDICARE: JENNIFER BAXTER STUFFLEBEAM PT

MEDICARE: JENNIFER BAXTER STUFFLEBEAM 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
1225100000XPhysical TherapistPT011974GA

General Provider Information

NPI Number : 1730686619
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER BAXTER STUFFLEBEAM PT
Provider Business Mailing Address
First Line : 7 CARNEGIE PLZ
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08003-1000
Country : US
Telephone Number : 877-407-3422
Fax Number : 877-407-4329
Provider Business Practice Location Address
First Line : 3500 LENOX RD NE STE 1500
Second Line :
City : ATLANTA
State : GA
Zip : 30326-4231
Country : US
Telephone Number : 877-407-3422
Fax Number : 877-407-4329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 04/09/2018

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