Provider Demographics
NPI:1609052216
Name:ELDER REESE, JENNIFER E (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:ELDER REESE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 W HIGHWAY 71
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8260
Mailing Address - Country:US
Mailing Address - Phone:512-288-2700
Mailing Address - Fax:512-288-2711
Practice Address - Street 1:7401 W HIGHWAY 71
Practice Address - Street 2:SUITE 130
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8260
Practice Address - Country:US
Practice Address - Phone:512-288-2700
Practice Address - Fax:512-288-2711
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2037968225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant