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NPI Code Detail

MEDICARE: JASMINE REDDIC PT

MEDICARE: JASMINE REDDIC 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
1225100000XPhysical Therapist
2225100000XPhysical Therapist1351982TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28QC361OTHERTXBCBS

General Provider Information

NPI Number : 1881360949
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE REDDIC PT
Provider Business Mailing Address
First Line : 9660 BARTLETT CIR STE 708
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-4465
Country : US
Telephone Number : 817-862-9665
Fax Number : 817-862-9667
Provider Business Practice Location Address
First Line : 9660 BARTLETT CIR STE 708
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-4465
Country : US
Telephone Number : 817-862-9665
Fax Number : 817-862-9667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2021
Last Update Date : 09/04/2024

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