Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1176400 | TX |
NPI | 1003130345 |
---|---|
Provider Name | Jennifer Lynn Mott |
First Address | Cedar Park, TX 78613-1642 |
Second Address | Cedar Park, TX 78613-1642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2010 |
Last Update Date | 16/03/2010 |