Provider Demographics
NPI:1639225774
Name:ISLAS, JENNIFER (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:ISLAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7903 SUNFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-324-4726
Mailing Address - Fax:
Practice Address - Street 1:15316 HUEBNER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248
Practice Address - Country:US
Practice Address - Phone:210-614-4567
Practice Address - Fax:210-614-4999
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1150910OtherLICENSE