Provider Demographics
NPI:1356439103
Name:KISH, JENNIFER CHRISTINAKI (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINAKI
Last Name:KISH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20322 HUEBNER RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3462
Mailing Address - Country:US
Mailing Address - Phone:210-494-4500
Mailing Address - Fax:210-494-4501
Practice Address - Street 1:20322 HUEBNER RD
Practice Address - Street 2:STE 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3462
Practice Address - Country:US
Practice Address - Phone:210-878-5359
Practice Address - Fax:210-878-5359
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11263652251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197595501Medicaid
TX8L1535Medicare PIN
TX197595501Medicaid