Healthcare Provider Details

I. General information

NPI: 1417543604
Provider Name (Legal Business Name): JENNIFER ANKLAM PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E STONY END PL
THE WOODLANDS TX
77381-6510
US

IV. Provider business mailing address

85 E STONY END PL
THE WOODLANDS TX
77381-6510
US

V. Phone/Fax

Practice location:
  • Phone: 713-471-5428
  • Fax:
Mailing address:
  • Phone: 713-471-5428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1409000
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2156985
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: