MEDICARE: REYSAN JAMOTUYA

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	1182130	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1182130	OTHER	TX	PT LICENSE NUMBER

General Provider Information

NPI Number	:	1164895447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYSAN JAMOTUYA

Provider Business Mailing Address
First Line	:	7710 FORT GRIFFIN DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-5783
Country	:	US
Telephone Number	:	361-343-1362
Fax Number	:

Provider Business Practice Location Address
First Line	:	7710 FORT GRIFFIN DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-5783
Country	:	US
Telephone Number	:	361-343-1362
Fax Number	:

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

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	11/09/2015

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Directions to “ REYSAN JAMOTUYA ” Practice Location

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