MEDICARE: MISS PHILECIA MARIE VASSELL PT

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	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1568769966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PHILECIA MARIE VASSELL PT

Provider Business Mailing Address
First Line	:	1660 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-3035
Country	:	US
Telephone Number	:	817-461-4257
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-3035
Country	:	US
Telephone Number	:	817-461-4257
Fax Number	:

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

Provider Enumeration Date	:	02/21/2011
Last Update Date	:	02/21/2011

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