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General NPI Number Information
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NPI Number | 1588575781
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Entity Type | Individual
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Provider Name | JESSICA LAMMERT FUSILIER
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Gender |
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 140 HILLCREST MEDICAL BLVD
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City | WACO
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State | TX
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Zip | 76712-8897
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Country | US
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Telephone | 254-202-7180
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Fax |
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Provider Business Mailing Address
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Address Line | 631 STEWART RD
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City | MCGREGOR
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State | TX
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Zip | 76657-3942
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Country | US
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Telephone |
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 1388961
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License Number State | TX
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