MEDICARE: JENNIFER PEDRAZA 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	225200000X	Physical Therapy Assistant	2076437	TX

General Provider Information

NPI Number	:	1912486945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PEDRAZA PTA

Provider Business Mailing Address
First Line	:	3171 SANDALWOOD DR
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-6019
Country	:	US
Telephone Number	:	832-459-3321
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 GULF AVE
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-3717
Country	:	US
Telephone Number	:	832-459-3321
Fax Number	:

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

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	08/10/2018

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Directions to “ JENNIFER PEDRAZA PTA” Practice Location

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