MEDICARE: MRS. JESSICA TABUADA 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	035609	NY

General Provider Information

NPI Number	:	1619306818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA TABUADA P.T.

Provider Business Mailing Address
First Line	:	1084 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2923
Country	:	US
Telephone Number	:	347-586-0625
Fax Number	:	347-586-0625

Provider Business Practice Location Address
First Line	:	1084 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2923
Country	:	US
Telephone Number	:	347-586-0625
Fax Number	:	347-586-0625

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	03/21/2025

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