Provider Demographics
NPI:1740246560
Name:DOYLE, JENNIFER ANN (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:TRAVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6121 SKOKIE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1382
Mailing Address - Country:US
Mailing Address - Phone:702-756-2552
Mailing Address - Fax:
Practice Address - Street 1:6121 SKOKIE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1382
Practice Address - Country:US
Practice Address - Phone:702-756-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
101832Medicare ID - Type Unspecified