MEDICARE: JACQUELINE JOY PHYSIOTHERAPY AND WELLNESS, LLC

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	:	1861110660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE JOY PHYSIOTHERAPY AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	2606 OCTAVIA ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-7050
Country	:	US
Telephone Number	:	850-324-5094
Fax Number	:	404-990-3529

Provider Business Practice Location Address
First Line	:	6024 MAGAZINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-5824
Country	:	US
Telephone Number	:	850-324-5094
Fax Number	:	404-990-3529

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	DR. JACQUELINE ROELOFS
Credential	:	PT, DPT
Telephone Number	:	850-324-5094

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	08/17/2022

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