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General NPI Number Information
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NPI Number | 1508413790
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Entity Type | Individual
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Provider Name | JESSICA MAE BEAUSOLEIL DPT, PT
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Gender | Female
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 930 W CENTERVILLE RD STE C
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City | GARLAND
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State | TX
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Zip | 75041-5854
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Country | US
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Telephone | 792-303-7021
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Fax |
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Provider Business Mailing Address
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Address Line | 2604 KIMBERLY LN
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City | PLANO
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State | TX
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Zip | 75075-6687
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Country | US
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Telephone | 860-428-4298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1320285
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License Number State | TX
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