Provider Demographics
NPI:1528288396
Name:CHILUK, JESSICA POTEET (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:POTEET
Last Name:CHILUK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LYNETTE
Other - Last Name:POTEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OCS, FAAOMPT
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:1300 DACY LN STE 100
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-4194
Practice Address - Country:US
Practice Address - Phone:512-213-8001
Practice Address - Fax:512-436-0874
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist