MEDICARE: MS. JANESSA ANN DEVEREUX D.P.T.

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	10504	CO

General Provider Information

NPI Number	:	1255563110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANESSA ANN DEVEREUX D.P.T.

Provider Business Mailing Address
First Line	:	1666 DETROIT ST
Second Line	:	APT #25
City	:	DENVER
State	:	CO
Zip	:	80206-1536
Country	:	US
Telephone Number	:	303-827-5513
Fax Number	:

Provider Business Practice Location Address
First Line	:	9950 W 80TH AVE
Second Line	:	SUITE 9
City	:	ARVADA
State	:	CO
Zip	:	80005-3927
Country	:	US
Telephone Number	:	303-422-1755
Fax Number	:	300-342-2371

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

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	08/13/2010

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