MEDICARE: JASON WAYNE RACCA P.T.

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	2251X0800X	Orthopedic Physical Therapist	1179207	TX

General Provider Information

NPI Number	:	1942486519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON WAYNE RACCA P.T.

Provider Business Mailing Address
First Line	:	11601 EMORY TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8805
Country	:	US
Telephone Number	:	817-221-8248
Fax Number	:	682-593-3599

Provider Business Practice Location Address
First Line	:	9800 HILLWOOD PKWY STE 140
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76177-1532
Country	:	US
Telephone Number	:	817-221-8248
Fax Number	:	682-593-3599

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

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	08/21/2021

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