MEDICARE: LISA HOPE JAIN

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	2251X0800X	Orthopedic Physical Therapist	PT871065	DC
2	2251X0800X	Orthopedic Physical Therapist	2011002798	MO

General Provider Information

NPI Number	:	1962635326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HOPE JAIN

Provider Business Mailing Address
First Line	:	1112 S ROCK HILL RD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 S ROCK HILL RD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3910
Country	:	US
Telephone Number	:	314-943-3814
Fax Number	:

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

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	11/16/2011

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Directions to “ LISA HOPE JAIN ” Practice Location

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