Jennifer S Paulley
Individual provider Active NPI Physical Therapist · Jay, FL
NPI 1124358403 · NPPES record last updated Dec 19, 2020
Key facts
- NPI
- 1124358403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 04226 (LA)
- Practice address
- 3964 Florida Ave
Jay, FL 32565-1104 - Phone
- (850) 741-6715
- NPI assigned
- Jan 8, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Action Therapy Group LLC
Practice addresses (Care Compare)
3964 Florida Ave
Jay, FL 32565-1104
Phone (850) 741-6715
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201221002310 | FL | Practitioner - Physical Therapist in Private Practice | 7416858808 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04226 | LA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Action Therapy Group LLC | Physical Therapist | Current |
Accepting new patients |
Locations
601 N Pearl St
Crestview, FL 32536
Phone (850) 689-7851
3964 Florida Ave
Jay, FL 32565
Phone (850) 675-4000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 04226 | LA | Yes |
Addresses
Primary practice location
3964 Florida Ave
Jay, FL 32565-1104
Mailing address
3331 Summit Blvd Apt 172
Pensacola, FL 32503-4331
Phone (850) 741-6715
Other practice location 1
210 Layton Ave
Monroe, LA 71201
Phone (318) 312-3640
Other providers in Jay, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.