Provider Demographics
NPI:1831700434
Name:ABELLA, JACQUELINE LO (PT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LO
Last Name:ABELLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:P
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1219 AUTUMN MIST WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-4531
Mailing Address - Country:US
Mailing Address - Phone:817-896-2294
Mailing Address - Fax:
Practice Address - Street 1:801 ROAD TO SIX FLAGS W STE 147
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2600
Practice Address - Country:US
Practice Address - Phone:817-462-8111
Practice Address - Fax:817-462-8110
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist