Provider Demographics
NPI:1720333644
Name:VILLEGAS, JESSICA JEANETTE (PT DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEANETTE
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GYNA DR
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8725
Mailing Address - Country:US
Mailing Address - Phone:830-774-1556
Mailing Address - Fax:830-774-6150
Practice Address - Street 1:1308 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-7818
Practice Address - Country:US
Practice Address - Phone:830-774-1556
Practice Address - Fax:830-774-6150
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1220145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist