MEDICARE: JEREMY MASCARENAS 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

General Provider Information

NPI Number	:	1841333127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY MASCARENAS P.T.

Provider Business Mailing Address
First Line	:	6357 E CAROLINA DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-1933
Country	:	US
Telephone Number	:	602-241-3145
Fax Number	:	602-241-3146

Provider Business Practice Location Address
First Line	:	539 E GLENDALE AVE
Second Line	:	SUITE 105
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4900
Country	:	US
Telephone Number	:	602-241-3145
Fax Number	:	602-241-3146

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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