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General NPI Number Information
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NPI Number | 1104402718
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Entity Type | Individual
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Provider Name | PATRICIA KAYE JAYNES ATC, LMT
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Gender | Female
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 11210 US 290, STE A230
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City | AUSTIN
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State | TX
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Zip | 78631
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Country | US
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Telephone | 512-362-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 13062 US 290 STE 100
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City | AUSTIN
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State | TX
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Zip | 78631
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Country | US
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Telephone | 512-362-8865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT132694
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT5816
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License Number State | TX
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