MEDICARE: JENNIFER L PRATT PT, 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
1	225100000X	Physical Therapist	PTL.0013674	CO

General Provider Information

NPI Number	:	1932456159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L PRATT PT, DPT

Provider Business Mailing Address
First Line	:	839 POPE DR
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-6532
Country	:	US
Telephone Number	:	440-228-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E HARMONY RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3280
Country	:	US
Telephone Number	:	970-221-1201
Fax Number	:

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	01/05/2016

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