MEDICARE: MR. JEFFREY LUM PT, MPT, DIP MDT

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	PT35353	CA
2	225100000X	Physical Therapist	1249361	TX

General Provider Information

NPI Number	:	1104069913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY LUM PT, MPT, DIP MDT

Provider Business Mailing Address
First Line	:	601 QUAIL VALLEY DR
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-8051
Country	:	US
Telephone Number	:	512-559-6551
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 QUAIL VALLEY DR
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-8051
Country	:	US
Telephone Number	:	512-559-6551
Fax Number	:	512-591-0789

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

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	11/20/2020

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