Provider Demographics
NPI:1891361051
Name:DURAN, JESSE LEEROY (PTA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LEEROY
Last Name:DURAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:LEEROY
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JESSE DURAN PTA
Mailing Address - Street 1:1064 CANADA WILD DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-5157
Mailing Address - Country:US
Mailing Address - Phone:806-407-2164
Mailing Address - Fax:
Practice Address - Street 1:711 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1330
Practice Address - Country:US
Practice Address - Phone:509-473-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2098701225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant