Individual
JESSICA MICHELLE PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4011 WILLIAMS DR, GEORGETOWN, TX 78628-2491
(512) 868-2700
Mailing address
9301 AXTELLON CT, AUSTIN, TX 78749-4168
(512) 743-4053
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2145800
TX
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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