MEDICARE: MRS. JOLENE KNEE PHYSICAL THERAPIST

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	12060	AZ

General Provider Information

NPI Number	:	1780126227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOLENE KNEE PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	4033 E FAIRMOUNT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5217
Country	:	US
Telephone Number	:	317-345-1687
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 W NORTHERN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5469
Country	:	US
Telephone Number	:	602-535-8255
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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