Provider Demographics
NPI:1386126233
Name:UBALDE, JEANNE MARIE SANTOS (PT, CLT)
Entity type:Individual
Prefix:
First Name:JEANNE MARIE
Middle Name:SANTOS
Last Name:UBALDE
Suffix:
Gender:F
Credentials:PT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 WALNUT HILL DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5052
Mailing Address - Country:US
Mailing Address - Phone:903-212-9456
Mailing Address - Fax:903-291-6305
Practice Address - Street 1:912 WALNUT HILL DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5052
Practice Address - Country:US
Practice Address - Phone:903-212-9456
Practice Address - Fax:903-291-6305
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1210835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist