MEDICARE: DR. JACQUELINE ECHEVERRIA DPT

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	6320	NV

General Provider Information

NPI Number	:	1700653409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE ECHEVERRIA DPT

Provider Business Mailing Address
First Line	:	1805 EVELYN AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-4218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 W BROOKS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3912
Country	:	US
Telephone Number	:	702-399-6545
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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