Provider Demographics
NPI:1245447531
Name:TUBBS, JENNA LEE (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LEE
Last Name:TUBBS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 FM 518 RD E
Mailing Address - Street 2:#616
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4376
Mailing Address - Country:US
Mailing Address - Phone:281-788-1833
Mailing Address - Fax:
Practice Address - Street 1:18100 SAINT JOHN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3631
Practice Address - Country:US
Practice Address - Phone:281-333-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT20632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer