Provider Demographics
NPI:1952724569
Name:BABCOCK, JAY S (DPT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:S
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3666
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3666
Mailing Address - Country:US
Mailing Address - Phone:361-275-0532
Mailing Address - Fax:361-275-8389
Practice Address - Street 1:5205 JOHN STOCKBAUER DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1866
Practice Address - Country:US
Practice Address - Phone:361-572-4246
Practice Address - Fax:361-572-9490
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1236919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist