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NPI Code Detail

MEDICARE: JEREMY JASSO

MEDICARE: JEREMY JASSO
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
1225200000XPhysical Therapy Assistant2083423TX

General Provider Information

NPI Number : 1740610088
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY JASSO
Provider Business Mailing Address
First Line : 1755 CRESCENT PLAZA DR APT 1072
Second Line :
City : HOUSTON
State : TX
Zip : 77077-5593
Country : US
Telephone Number : 832-414-3035
Fax Number :
Provider Business Practice Location Address
First Line : 1755 CRESCENT PLAZA DR APT 1072
Second Line :
City : HOUSTON
State : TX
Zip : 77077-5593
Country : US
Telephone Number : 832-414-3035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2013
Last Update Date : 11/23/2013

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