MEDICARE: JOSEPH L MEZA 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	143867	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00200127	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT143867	OTHER	TX	WORKERS COMP
3	658373	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1346463809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH L MEZA P.T.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	04/14/2008

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