MEDICARE: JASMINE T SIA 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	070014158	IL
2	225100000X	Physical Therapist	10699	MN

General Provider Information

NPI Number	:	1972723559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE T SIA PT

Provider Business Mailing Address
First Line	:	10259 3RD ST NE UNIT A
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55434-5407
Country	:	US
Telephone Number	:	630-201-1089
Fax Number	:

Provider Business Practice Location Address
First Line	:	2945 HAZELWOOD ST
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1241
Country	:	US
Telephone Number	:	651-364-6356
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	09/25/2024

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