Individual
MRS. JESSICA DAWN JAQUESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1391 GROVE DR, CLOVIS, NM 88101-1110
(575) 703-5281
Mailing address
1391 GROVE DR, CLOVIS, NM 88101
(575) 703-5281
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-1629
NM
Other
Enumeration date
01/12/2017
Last updated
01/12/2017
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