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NPI Code Detail

MEDICARE: EMILY E WASCOMB DPT

MEDICARE: EMILY E WASCOMB DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1304961TX

General Provider Information

NPI Number : 1235618869
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY E WASCOMB DPT
Provider Business Mailing Address
First Line : 1001 12TH AVE STE 201
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3946
Country : US
Telephone Number : 817-719-7714
Fax Number :
Provider Business Practice Location Address
First Line : 1001 12TH AVE STE 201
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3946
Country : US
Telephone Number : 817-719-7714
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2018
Last Update Date : 09/16/2022

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