MEDICARE: MR. FRANK JAESCHKE PTA, MED

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	225200000X	Physical Therapy Assistant	2050258	TX

General Provider Information

NPI Number	:	1316067879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK JAESCHKE PTA, MED

Provider Business Mailing Address
First Line	:	2100 WEST LOOP S
Second Line	:	STE 1525
City	:	HOUSTON
State	:	TX
Zip	:	77027-3515
Country	:	US
Telephone Number	:	713-965-9998
Fax Number	:	713-965-9921

Provider Business Practice Location Address
First Line	:	2100 WEST LOOP S
Second Line	:	STE 1525
City	:	HOUSTON
State	:	TX
Zip	:	77027-3515
Country	:	US
Telephone Number	:	713-965-9998
Fax Number	:	713-965-9921

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	05/17/2011

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