MEDICARE: MS. JESSICA CHAVEZ LMT

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	225700000X	Massage Therapist	MT134670	TX

General Provider Information

NPI Number	:	1366168197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA CHAVEZ LMT

Provider Business Mailing Address
First Line	:	3700 LEGACY DR APT 3102
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-6632
Country	:	US
Telephone Number	:	325-227-1560
Fax Number	:

Provider Business Practice Location Address
First Line	:	7035 GREENVILLE AVE STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5109
Country	:	US
Telephone Number	:	972-295-0155
Fax Number	:

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

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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