Basic Information
| Provider Information | |||||||||
| NPI: | 1215174222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HITTLE | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1543 GRANT ST | ||||||||
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| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460601952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175731037 | ||||||||
| FaxNumber: | 8667854924 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460322923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175731037 | ||||||||
| FaxNumber: | 8667854924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2009 | ||||||||
| LastUpdateDate: | 01/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 06002975A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.