Healthcare Provider Details

I. General information

NPI: 1073700274
Provider Name (Legal Business Name): JAMIE LOGSDON REESE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST SUITE C-11
AUSTIN TX
78705-1121
US

IV. Provider business mailing address

12508 JONES MALTSBERGER RD STE. 110
SAN ANTONIO TX
78247-4214
US

V. Phone/Fax

Practice location:
  • Phone: 512-302-3922
  • Fax: 512-795-0688
Mailing address:
  • Phone: 888-590-4002
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1177153
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: