Provider Demographics
NPI:1184732646
Name:JAQUES, HEATHER JEAN
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEAN
Last Name:JAQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2428
Mailing Address - Country:US
Mailing Address - Phone:408-267-7104
Mailing Address - Fax:408-946-5476
Practice Address - Street 1:1717 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6756
Practice Address - Country:US
Practice Address - Phone:408-957-5718
Practice Address - Fax:408-946-5476
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6008225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant