Provider Demographics
NPI:1073267928
Name:PACK, JAYME RAE (DPT)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:RAE
Last Name:PACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 GRANT RD STE 900
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4094
Mailing Address - Country:US
Mailing Address - Phone:832-220-9211
Mailing Address - Fax:832-610-2354
Practice Address - Street 1:13215 GRANT RD STE 900
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4094
Practice Address - Country:US
Practice Address - Phone:832-220-9211
Practice Address - Fax:832-610-2354
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1357143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist