Provider Demographics
NPI:1487688156
Name:SOUZA, JESSICA KAY (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAY
Last Name:SOUZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-0388
Mailing Address - Country:US
Mailing Address - Phone:817-706-8174
Mailing Address - Fax:903-577-3701
Practice Address - Street 1:400 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-4456
Practice Address - Country:US
Practice Address - Phone:903-577-3700
Practice Address - Fax:903-577-3701
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1167953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist