MEDICARE: MARCO RODRIGO JEREZ PT, DPT

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	1286893	TX

General Provider Information

NPI Number	:	1992338586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO RODRIGO JEREZ PT, DPT

Provider Business Mailing Address
First Line	:	2626 W SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-1606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 W SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-1606
Country	:	US
Telephone Number	:	713-996-9209
Fax Number	:

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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