MEDICARE: JANSEN YAMOUT 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	1258255	TX
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1639557259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANSEN YAMOUT PT

Provider Business Mailing Address
First Line	:	PO BOX 35232
Second Line	:	ATTN: CREDENTIALING
City	:	BELFAST
State	:	ME
Zip	:	04915-0630
Country	:	US
Telephone Number	:	469-864-6290
Fax Number	:

Provider Business Practice Location Address
First Line	:	2716 TRAVIS DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2089
Country	:	US
Telephone Number	:	817-375-5200
Fax Number	:

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

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	06/12/2025

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Directions to “ JANSEN YAMOUT PT” Practice Location

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