Provider Demographics
NPI:1285747568
Name:LIN, JEAN W (PT)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:W
Last Name:LIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:WAN
Other - Middle Name:CHEN
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11589 S WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4752
Mailing Address - Country:US
Mailing Address - Phone:281-575-8288
Mailing Address - Fax:281-575-6833
Practice Address - Street 1:11589 S WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4752
Practice Address - Country:US
Practice Address - Phone:281-575-8288
Practice Address - Fax:281-575-6833
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142950802Medicaid
TX142950803Medicaid
TX142950803Medicaid