Provider Demographics
NPI:1417625062
Name:ACOSTA, JANCE ARACELY (PT,DPT)
Entity Type:Individual
Prefix:
First Name:JANCE
Middle Name:ARACELY
Last Name:ACOSTA
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 1:2202 BARRINGTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-1852
Mailing Address - Country:US
Mailing Address - Phone:713-449-8302
Mailing Address - Fax:
Practice Address - Street 1:2500 FONDREN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2308
Practice Address - Country:US
Practice Address - Phone:832-252-8055
Practice Address - Fax:813-252-8058
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1349982208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation