Provider Demographics
NPI:1003161423
Name:ALCALA, JENNIFER LOREN (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOREN
Last Name:ALCALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-4916
Mailing Address - Country:US
Mailing Address - Phone:915-593-4985
Mailing Address - Fax:915-593-5187
Practice Address - Street 1:8111 N LOOP DR
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4159
Practice Address - Country:US
Practice Address - Phone:915-593-4985
Practice Address - Fax:915-593-5187
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1218512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist