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General NPI Number Information
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NPI Number | 1750855656
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Entity Type | Individual
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Provider Name | JILLIAN NICOLE SWEENEY PTA
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Gender | Female
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 9014 TIMBER PATH
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City | SAN ANTONIO
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State | TX
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Zip | 78250-4172
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Country | US
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Telephone | 210-523-2455
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Fax |
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Provider Business Mailing Address
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Address Line | 14030 FM 1560 N APT 2110
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City | HELOTES
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State | TX
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Zip | 78023-4802
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Country | US
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Telephone | 210-478-0886
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2143331
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License Number State | TX
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