MEDICARE: JESSICA LYNN WINDER MSPT

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	PT018577	PA

General Provider Information

NPI Number	:	1942254271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN WINDER MSPT

Provider Business Mailing Address
First Line	:	132 OLD BERWICK HWY
Second Line	:
City	:	NESCOPECK
State	:	PA
Zip	:	18635-1922
Country	:	US
Telephone Number	:	570-594-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 FOWLER AVE STE 104
Second Line	:
City	:	BERWICK
State	:	PA
Zip	:	18603-3326
Country	:	US
Telephone Number	:	570-290-9401
Fax Number	:

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/09/2011

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