MEDICARE: MISS JESSICA MEHSIKOMER PTA

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	225700000X	Massage Therapist
2	225200000X	Physical Therapy Assistant	PTA0013427	CO
3	225200000X	Physical Therapy Assistant	A-1341	NM

General Provider Information

NPI Number	:	1902160427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA MEHSIKOMER PTA

Provider Business Mailing Address
First Line	:	8789 W EASTMAN DR
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-4721
Country	:	US
Telephone Number	:	913-909-5586
Fax Number	:

Provider Business Practice Location Address
First Line	:	5830 CORAL RIDGE DR STE 300
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3388
Country	:	US
Telephone Number	:	954-752-6974
Fax Number	:

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

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	12/29/2016

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