Individual
JENNICA VAUGHAN RADLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
85 NE LOOP 410 STE 612, SAN ANTONIO, TX 78216-5866
(210) 494-2343
Mailing address
85 NE LOOP 410 STE 612, SAN ANTONIO, TX 78216-5866
(801) 721-9170
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2086140
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2086140
PHYSICAL THERAPY
TX
Enumeration date
06/12/2012
Last updated
06/12/2012
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