Provider Demographics
NPI:1447734066
Name:BABER, JENNA MAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MAE
Last Name:BABER
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 1:2205 W WALKER ST APT 2120
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6893
Mailing Address - Country:US
Mailing Address - Phone:816-645-5281
Mailing Address - Fax:
Practice Address - Street 1:2785 GULF FWY S STE 125
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4993
Practice Address - Country:US
Practice Address - Phone:281-534-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1304989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist