MEDICARE: JASON V VILLANO 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	1074185	TX

General Provider Information

NPI Number	:	1396712766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON V VILLANO P.T.

Provider Business Mailing Address
First Line	:	PO BOX 542033
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-2033
Country	:	US
Telephone Number	:	214-988-1189
Fax Number	:	214-988-1189

Provider Business Practice Location Address
First Line	:	8610 GREENVILLE AVE
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75243-7144
Country	:	US
Telephone Number	:	214-503-7700
Fax Number	:

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/08/2007

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