Provider Demographics
NPI:1750001756
Name:TEJADA, JHULMA TABURNAL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JHULMA
Middle Name:TABURNAL
Last Name:TEJADA
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 1:1102 W EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76374-1026
Mailing Address - Country:US
Mailing Address - Phone:940-250-9699
Mailing Address - Fax:
Practice Address - Street 1:100 S AVENUE M
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374-1642
Practice Address - Country:US
Practice Address - Phone:940-564-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1234079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist