MEDICARE: JASMINE MASCARENES D.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	12400	AZ

General Provider Information

NPI Number	:	1710430590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE MASCARENES D.P.T

Provider Business Mailing Address
First Line	:	1777 W SAINT MARYS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2687
Country	:	US
Telephone Number	:	520-884-9819
Fax Number	:

Provider Business Practice Location Address
First Line	:	8987 E TANQUE VERDE RD
Second Line	:	301
City	:	TUCSON
State	:	AZ
Zip	:	85749-9610
Country	:	US
Telephone Number	:	520-884-9819
Fax Number	:

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

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	04/10/2017

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