MEDICARE: CHAMELIA J JEFFERSON PTA

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
1	225200000X	Physical Therapy Assistant	2012019887	MO
2	225200000X	Physical Therapy Assistant	2137410	TX

General Provider Information

NPI Number	:	1346504370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAMELIA J JEFFERSON PTA

Provider Business Mailing Address
First Line	:	9382 WHISTLE STOP PL APT 1217B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-1251
Country	:	US
Telephone Number	:	314-882-3059
Fax Number	:

Provider Business Practice Location Address
First Line	:	9382 WHISTLE STOP PL APT 1217B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-1251
Country	:	US
Telephone Number	:	314-882-3059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	07/24/2024

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Directions to “ CHAMELIA J JEFFERSON PTA” Practice Location

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