Provider Demographics
NPI:1366966772
Name:JEDLICKA, EMILY HOLMBERG (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:HOLMBERG
Last Name:JEDLICKA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13502 FAWCETT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-2452
Mailing Address - Country:US
Mailing Address - Phone:502-424-2649
Mailing Address - Fax:
Practice Address - Street 1:1803 W WHITE OAK TER STE C
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3675
Practice Address - Country:US
Practice Address - Phone:936-494-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist