Provider Demographics
NPI:1235619990
Name:CLIFTON, JESSICA ROSE (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:CLIFTON
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 1:416 WILDCAT CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-5670
Mailing Address - Country:US
Mailing Address - Phone:254-749-6380
Mailing Address - Fax:
Practice Address - Street 1:503 MEADOW DR
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1018
Practice Address - Country:US
Practice Address - Phone:254-826-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2069708225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant