Healthcare Provider Details

I. General information

NPI: 1598422172
Provider Name (Legal Business Name): JACLYN LEA TOEWS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 HARRY HINES BLVD
DALLAS TX
75390-0001
US

IV. Provider business mailing address

7510 E GRAND AVE APT 1115
DALLAS TX
75214-4161
US

V. Phone/Fax

Practice location:
  • Phone: 214-633-4794
  • Fax:
Mailing address:
  • Phone: 434-660-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1332196
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: