Provider Demographics
NPI:1649316027
Name:MILLIKEN, JENNIFER CLAIRE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:CLAIRE
Other - Last Name:GARARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2395 BULVERDE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4571
Mailing Address - Country:US
Mailing Address - Phone:830-980-6880
Mailing Address - Fax:830-980-6881
Practice Address - Street 1:2395 BULVERDE RD.
Practice Address - Street 2:SUITE 104
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-4571
Practice Address - Country:US
Practice Address - Phone:830-980-6880
Practice Address - Fax:830-980-6881
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6128OtherBCBS PIN
TX00636YMedicare PIN
TX8K9590Medicare PIN