=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073700274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE LOGSDON REESE PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2007
-----------------------------------------------------
Last Update Date | 03/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 W 38TH ST SUITE C-11
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78705-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-302-3922
-----------------------------------------------------
Fax | 512-795-0688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12508 JONES MALTSBERGER RD STE. 110
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78247-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-590-4002
-----------------------------------------------------
Fax | 210-590-4585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1177153
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------