MEDICARE: JOSEPH L. MEZA

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	143867	TX

General Provider Information

NPI Number	:	1316969249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH L. MEZA

Provider Business Mailing Address
First Line	:	PO BOX 1193
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-1193
Country	:	US
Telephone Number	:	281-334-2560
Fax Number	:	281-238-8401

Provider Business Practice Location Address
First Line	:	3000 INVINCIBLE CIR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2956
Country	:	US
Telephone Number	:	281-334-2560
Fax Number	:	281-238-8401

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH LEE MEZA
Credential	:	P.T.
Telephone Number	:	281-334-2560

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	06/30/2008

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