Basic Information
| Provider Information | |||||||||
| NPI: | 1659701795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEHL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W OLLIE ST | ||||||||
| Address2: | |||||||||
| City: | LLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786432628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302017141 | ||||||||
| FaxNumber: | 8302017143 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W HIGHWAY 71 | ||||||||
| Address2: | |||||||||
| City: | MARBLE FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786548602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302017141 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2013 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1157263 | TX | Y | Other Service Providers | Specialist |
No ID Information.