Basic Information
Provider Information
NPI: 1356654669
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCOTT
FirstName: JENNIFER
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2001 MALLORY LN
Address2: STE 201
City: FRANKLIN
State: TN
PostalCode: 370678233
CountryCode: US
TelephoneNumber: 6153731350
FaxNumber: 6153737116
Practice Location
Address1: 2001 MALLORY LN
Address2: STE 201
City: FRANKLIN
State: TN
PostalCode: 370678233
CountryCode: US
TelephoneNumber: 6157710134
FaxNumber: 6157718816
Other Information
ProviderEnumerationDate: 07/16/2010
LastUpdateDate: 07/16/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X8672TNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home