Healthcare Provider Details

I. General information

NPI: 1972116416
Provider Name (Legal Business Name): JASMINE M. RENDEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

350 MISSOURI WAY
TRAVIS AFB CA
94535-1201
US

V. Phone/Fax

Practice location:
  • Phone: 210-801-9301
  • Fax:
Mailing address:
  • Phone: 402-639-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA7280
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: