MEDICARE: MRS. MELISSA ANNE JEZEK PT

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	1987	NV

General Provider Information

NPI Number	:	1861656936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA ANNE JEZEK PT

Provider Business Mailing Address
First Line	:	982 HILLTOP DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89705-8099
Country	:	US
Telephone Number	:	775-267-0205
Fax Number	:

Provider Business Practice Location Address
First Line	:	982 HILLTOP DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89705-8099
Country	:	US
Telephone Number	:	775-267-0205
Fax Number	:

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

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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