Healthcare Provider Details

I. General information

NPI: 1427468511
Provider Name (Legal Business Name): JESSICA MARIE VALLE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 CHERRY RIDGE ST STE D400
SAN ANTONIO TX
78230-4820
US

IV. Provider business mailing address

6604 CHARLES FLD
SAN ANTONIO TX
78238-3023
US

V. Phone/Fax

Practice location:
  • Phone: 210-692-0222
  • Fax: 210-692-0223
Mailing address:
  • Phone: 210-219-6418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1198702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: