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NPI Code Detail

MEDICARE: JENNY NELSON P.T.A

MEDICARE: JENNY NELSON P.T.A
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
1225200000XPhysical Therapy Assistant4465MT

General Provider Information

NPI Number : 1942756853
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY NELSON P.T.A
Provider Business Mailing Address
First Line : 1343 US HIGHWAY 93 N
Second Line :
City : EUREKA
State : MT
Zip : 59917-9503
Country : US
Telephone Number : 406-297-3915
Fax Number :
Provider Business Practice Location Address
First Line : 1343 US HIGHWAY 93 N
Second Line :
City : EUREKA
State : MT
Zip : 59917-9503
Country : US
Telephone Number : 406-297-3915
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2016
Last Update Date : 03/27/2017

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