Basic Information
| Provider Information | |||||||||
| NPI: | 1063468940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANCHESON | ||||||||
| FirstName: | KAREN | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 JACKSON CT | ||||||||
| Address2: | |||||||||
| City: | SATELLITE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329373932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217735757 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900VETERANS WAY | ||||||||
| Address2: | VA OUTPATIENT CLINIC | ||||||||
| City: | VIERA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216373788 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT0007726 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.