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General NPI Number Information
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NPI Number | 1386883478
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Entity Type | Individual
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Provider Name | JENNIFER WELLS MCCAULEY P.T.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 280 COMMERCE ST STE 115
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7544
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Country | US
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Telephone | 817-912-1420
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Fax | 817-668-7640
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Provider Business Mailing Address
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Address Line | 280 COMMERCE ST STE 115
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7544
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Country | US
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Telephone | 817-912-1420
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Fax | 817-668-7640
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT870977
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 37507
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1295719
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License Number State | TX
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