MEDICARE: JENNIFER DENISE VASQUEZ 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
1	225100000X	Physical Therapist	1378527	TX

General Provider Information

NPI Number	:	1588345664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DENISE VASQUEZ DPT

Provider Business Mailing Address
First Line	:	8401 BOULEVARD 26 STE 14
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-5811
Country	:	US
Telephone Number	:	817-898-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 BOULEVARD 26 STE 14
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-5811
Country	:	US
Telephone Number	:	817-898-8444
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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