Provider Demographics
NPI:1336501840
Name:ARIZOLA, JESSICA RAE (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:ARIZOLA
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 1:26315 CUYAHOGA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-3570
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LONE STAR PASS
Practice Address - Street 2:BLDG 46
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78264-3638
Practice Address - Country:US
Practice Address - Phone:210-263-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2111435225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant