Provider Demographics
NPI:1548901887
Name:BUSWELL, JENNIFER RENE (MPT, CFPS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENE
Last Name:BUSWELL
Suffix:
Gender:F
Credentials:MPT, CFPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2903
Mailing Address - Country:US
Mailing Address - Phone:573-582-8888
Mailing Address - Fax:
Practice Address - Street 1:711 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2903
Practice Address - Country:US
Practice Address - Phone:573-582-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005050542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist