Basic Information
| Provider Information | |||||||||
| NPI: | 1982866612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOVER | ||||||||
| FirstName: | JENIFER | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PTA, MT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 GAYLORD PKWY | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750348664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723774111 | ||||||||
| FaxNumber: | 9723774148 | ||||||||
| Practice Location | |||||||||
| Address1: | 3010 GAYLORD PKWY | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750348664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723774111 | ||||||||
| FaxNumber: | 9723774148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 06/25/2008 | ||||||||
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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 | 225200000X | 2052768 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225700000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.