Provider Demographics
NPI:1336906510
Name:ROCHA, JACQUELINE DANIELLE (DPT PT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DANIELLE
Last Name:ROCHA
Suffix:
Gender:F
Credentials:DPT PT
Other - Prefix:
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Mailing Address - Street 1:12413 JUDSON RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3262
Mailing Address - Country:US
Mailing Address - Phone:210-614-7953
Mailing Address - Fax:210-614-4190
Practice Address - Street 1:2140 BABCOCK RD STE 130
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4400
Practice Address - Country:US
Practice Address - Phone:210-614-7953
Practice Address - Fax:210-614-4190
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1362145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist