Provider Demographics
NPI:1386883478
Name:MCCAULEY, JENNIFER WELLS (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WELLS
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 COMMERCE ST STE 115
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7544
Mailing Address - Country:US
Mailing Address - Phone:817-912-1420
Mailing Address - Fax:817-668-7640
Practice Address - Street 1:280 COMMERCE ST STE 115
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7544
Practice Address - Country:US
Practice Address - Phone:817-912-1420
Practice Address - Fax:817-668-7640
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870977225100000X
CA375072251X0800X
TX12957192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist