Provider Demographics
NPI:1770585960
Name:COMER, JENNIFER D (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:COMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W DAWN DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-2110
Mailing Address - Country:US
Mailing Address - Phone:520-797-2090
Mailing Address - Fax:520-797-3138
Practice Address - Street 1:1880 W ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1129
Practice Address - Country:US
Practice Address - Phone:520-797-2090
Practice Address - Fax:520-797-3138
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0461270OtherBLUE CROSS BLUE SHIELD AZ
AZ5688OtherHEALTH NET
AZ1919493OtherFIRST HEALTH
AZ0461270OtherBLUE CROSS BLUE SHIELD AZ
AZP33171Medicare UPIN