Provider Demographics
NPI:1780384537
Name:RODELL, JAMIE RENEE (PTA, DPT)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:RENEE
Last Name:RODELL
Suffix:
Gender:F
Credentials:PTA, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13814 CANE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4476
Mailing Address - Country:US
Mailing Address - Phone:210-721-0311
Mailing Address - Fax:
Practice Address - Street 1:5917 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5235
Practice Address - Country:US
Practice Address - Phone:210-253-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
TX2145778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant