Provider Demographics
NPI:1104402718
Name:JAYNES, PATRICIA KAYE (ATC, LMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAYE
Last Name:JAYNES
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13062 US 290
Mailing Address - Street 2:STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78631
Mailing Address - Country:US
Mailing Address - Phone:512-362-8865
Mailing Address - Fax:
Practice Address - Street 1:11210 US 290, STE A230
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78631
Practice Address - Country:US
Practice Address - Phone:512-362-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT132694225700000X
TXAT58162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist