Provider Demographics
NPI:1720044332
Name:ATKINS, JACQUELIN SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELIN
Middle Name:SUE
Last Name:ATKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4356
Mailing Address - Street 2:DEPT 665
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4356
Mailing Address - Country:US
Mailing Address - Phone:281-440-6960
Mailing Address - Fax:281-440-6205
Practice Address - Street 1:17270 RED OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2632
Practice Address - Country:US
Practice Address - Phone:281-440-6960
Practice Address - Fax:281-440-6205
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6315Medicare ID - Type Unspecified
R77456Medicare UPIN