MEDICARE: JESSICA PASQUARIELLO PT, 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	225200000X	Physical Therapy Assistant	24962	FL
2	225100000X	Physical Therapist	PT44362	FL

General Provider Information

NPI Number	:	1790352961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PASQUARIELLO PT, DPT

Provider Business Mailing Address
First Line	:	1400 HAND AVE STE Q
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8196
Country	:	US
Telephone Number	:	386-673-9880
Fax Number	:	386-673-5841

Provider Business Practice Location Address
First Line	:	1400 HAND AVE STE Q
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8196
Country	:	US
Telephone Number	:	386-673-9880
Fax Number	:	386-673-5841

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

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	04/21/2026

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