Provider Demographics
NPI:1801520424
Name:JAKOVLJEIVC, JELENA
Entity type:Individual
Prefix:
First Name:JELENA
Middle Name:
Last Name:JAKOVLJEIVC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 N LAKE CREEK PKWY APT 3319
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5975
Mailing Address - Country:US
Mailing Address - Phone:925-699-7845
Mailing Address - Fax:
Practice Address - Street 1:3110 GUADALUPE ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2858
Practice Address - Country:US
Practice Address - Phone:512-675-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1330816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist