MEDICARE: JESSICA JEANETTE VILLEGAS PT 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	1220145	TX

General Provider Information

NPI Number	:	1720333644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA JEANETTE VILLEGAS PT DPT

Provider Business Mailing Address
First Line	:	115 GYNA DR
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78840-8725
Country	:	US
Telephone Number	:	830-774-1556
Fax Number	:	830-774-6150

Provider Business Practice Location Address
First Line	:	1308 N BEDELL AVE
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78840-7818
Country	:	US
Telephone Number	:	830-774-1556
Fax Number	:	830-774-6150

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

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	06/05/2013

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