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NPI Code Detail

MEDICARE: JACQUELYN M HARTFIELD PTA

MEDICARE: JACQUELYN M HARTFIELD PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2071210TX

General Provider Information

NPI Number : 1649750381
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN M HARTFIELD PTA
Provider Business Mailing Address
First Line : 6751 INDIAN LDG
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78253-4409
Country : US
Telephone Number : 210-214-2659
Fax Number :
Provider Business Practice Location Address
First Line : 8707 LAKESIDE PKWY
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78245-3245
Country : US
Telephone Number : 210-510-3200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2018
Last Update Date : 08/21/2018

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