Provider Demographics
NPI:1568943553
Name:CARRASCO, JESSICA RAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RAE
Last Name:CARRASCO
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 1:507 STOREY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3330
Mailing Address - Country:US
Mailing Address - Phone:432-260-1078
Mailing Address - Fax:
Practice Address - Street 1:801 S LOOP 250 W
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-2134
Practice Address - Country:US
Practice Address - Phone:432-689-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist