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NPI Code Detail

MEDICARE: JENNA LEIGH LILLPOP P.T., DPT

MEDICARE: JENNA LEIGH LILLPOP P.T., DPT
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 Therapist05009863AIN

General Provider Information

NPI Number : 1871824631
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA LEIGH LILLPOP P.T., DPT
Provider Business Mailing Address
First Line : 712 W 2ND ST
Second Line :
City : LEAVENWORTH
State : IN
Zip : 47137-2264
Country : US
Telephone Number : 812-738-2292
Fax Number :
Provider Business Practice Location Address
First Line : 712 W 2ND ST
Second Line :
City : LEAVENWORTH
State : IN
Zip : 47137-2264
Country : US
Telephone Number : 812-738-2292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2010
Last Update Date : 01/19/2010

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