MEDICARE: JENNIFER RICHARD 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	8168	MA

General Provider Information

NPI Number	:	1821077892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RICHARD PT

Provider Business Mailing Address
First Line	:	46 MERCER ST APT 1
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-5524
Country	:	US
Telephone Number	:	617-851-0552
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 MERCER ST APT 1
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-5524
Country	:	US
Telephone Number	:	617-851-0552
Fax Number	:

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	03/19/2023

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Directions to “ JENNIFER RICHARD PT” Practice Location

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