Provider Demographics
NPI:1710644125
Name:ABRAHAM, JESSTIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSTIN
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
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 1:3408 WILLOWCREEK DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4009
Mailing Address - Country:US
Mailing Address - Phone:469-644-8135
Mailing Address - Fax:
Practice Address - Street 1:819 E MOORE AVE STE C
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3230
Practice Address - Country:US
Practice Address - Phone:972-551-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy