Provider Demographics
NPI:1083196893
Name:VALLES, JAYME (PTA)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:VALLES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 DAWNS PEAK
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-4053
Mailing Address - Country:US
Mailing Address - Phone:512-564-3058
Mailing Address - Fax:
Practice Address - Street 1:810 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-1722
Practice Address - Country:US
Practice Address - Phone:254-547-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2105727208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation