Provider Demographics
NPI:1770063828
Name:BARRERA, JACQUELINE (PTA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BARRERA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14200 VANCE JACKSON RD APT 24301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1971
Mailing Address - Country:US
Mailing Address - Phone:210-440-3372
Mailing Address - Fax:
Practice Address - Street 1:3838 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3556
Practice Address - Country:US
Practice Address - Phone:210-581-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2117063208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation