Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1161850 | TX |
NPI | 1093024002 |
---|---|
Provider Name | Mrs. Jennifer Jane Zoll |
First Address | Fort Worth, TX 76123-1817 |
Second Address | Fort Worth, TX 76123-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2010 |
Last Update Date | 26/09/2010 |