MEDICARE: MR. JEAN-VICTOR JAVIER RPT

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	11-04060	KS

General Provider Information

NPI Number	:	1083928824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEAN-VICTOR JAVIER RPT

Provider Business Mailing Address
First Line	:	257 S 5TH ST
Second Line	:	APT.1
City	:	SALINA
State	:	KS
Zip	:	67401-3990
Country	:	US
Telephone Number	:	785-787-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 S 3RD ST
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-4104
Country	:	US
Telephone Number	:	785-826-1998
Fax Number	:

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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