Provider Demographics
NPI:1235581661
Name:BASILAN, JANNETTE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:JANNETTE
Middle Name:
Last Name:BASILAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 ASHBURTON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2529
Mailing Address - Country:US
Mailing Address - Phone:561-543-4861
Mailing Address - Fax:
Practice Address - Street 1:8107 ASHBURTON
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2529
Practice Address - Country:US
Practice Address - Phone:561-543-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1227817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist