Provider Demographics
NPI:1730709791
Name:FOLEY, JACQUELYNN WARD (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:WARD
Last Name:FOLEY
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CANDLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4331
Mailing Address - Country:US
Mailing Address - Phone:281-216-7064
Mailing Address - Fax:
Practice Address - Street 1:2200 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3143
Practice Address - Country:US
Practice Address - Phone:469-752-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT50472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty