Provider Demographics
NPI:1508164104
Name:BESCH, JENNIFER JO (RPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JO
Last Name:BESCH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:JO
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:2112 ARBOR BEND ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2226
Mailing Address - Country:US
Mailing Address - Phone:903-640-4545
Mailing Address - Fax:903-640-4545
Practice Address - Street 1:2501 N CENTER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2114
Practice Address - Country:US
Practice Address - Phone:903-583-3562
Practice Address - Fax:903-583-8636
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist