MEDICARE: BROOKS JENNIFER ACEVEDO BALBUENA

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1598629156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKS JENNIFER ACEVEDO BALBUENA

Provider Business Mailing Address
First Line	:	19620 VEDURO CIR APT 302
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5544
Country	:	US
Telephone Number	:	419-356-7174
Fax Number	:	419-356-7174

Provider Business Practice Location Address
First Line	:	19620 VEDURO CIR APT 302
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5544
Country	:	US
Telephone Number	:	419-356-7174
Fax Number	:	419-356-7174

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ BROOKS JENNIFER ACEVEDO BALBUENA ” Practice Location

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