Provider Demographics
NPI:1629402672
Name:ELLIOTT, JENNA L (PT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:L
Other - Last Name:RAUSHECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1905 DOVE CROSSING LN
Mailing Address - Street 2:SUITE AB
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-5272
Mailing Address - Country:US
Mailing Address - Phone:936-870-3475
Mailing Address - Fax:936-870-3476
Practice Address - Street 1:1905 DOVE CROSSING LN
Practice Address - Street 2:SUITE AB
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-5272
Practice Address - Country:US
Practice Address - Phone:936-870-3475
Practice Address - Fax:936-870-3476
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist