Healthcare Provider Details

I. General information

NPI: 1023343985
Provider Name (Legal Business Name): JESSICA LYNN DUGAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 FOUR WINDS DR SUITE 109
SAN ANTONIO TX
78239-1970
US

IV. Provider business mailing address

7126 WASHITA WAY
SAN ANTONIO TX
78256-2339
US

V. Phone/Fax

Practice location:
  • Phone: 888-590-4002
  • Fax: 210-590-4585
Mailing address:
  • Phone: 314-853-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1147882
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: