Provider Demographics
NPI:1720411499
Name:WINDLE, JACQUELINE RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:RENEE
Last Name:WINDLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:RENEE
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4621 W PARK BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-985-1776
Mailing Address - Fax:972-985-6088
Practice Address - Street 1:4621 W PARK BLVD
Practice Address - Street 2:STE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2318
Practice Address - Country:US
Practice Address - Phone:972-985-1776
Practice Address - Fax:972-985-6088
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1234840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist