Basic Information
| Provider Information | |||||||||
| NPI: | 1801954953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADGER | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3305 S ORANGE AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078523310 | ||||||||
| FaxNumber: | 4078523301 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 S DILLARD ST | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347873903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079050531 | ||||||||
| FaxNumber: | 4079050532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 01/19/2011 | ||||||||
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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 | PT 20484 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 888273800 | 05 | FL | MEDICAID |