Provider Demographics
NPI:1003341603
Name:MORALES, JESSICA RENEE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:MORALES
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:HILGENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-8819
Mailing Address - Country:US
Mailing Address - Phone:512-618-2141
Mailing Address - Fax:
Practice Address - Street 1:18300 SAINT JOHN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-6302
Practice Address - Country:US
Practice Address - Phone:281-333-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT 43392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer