Provider Demographics
NPI:1558678565
Name:BATARA, JENNILYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNILYN
Middle Name:
Last Name:BATARA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNILYN
Other - Middle Name:
Other - Last Name:BATARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8515 FANNIN ST STE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8675 W ROME BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1291
Practice Address - Country:US
Practice Address - Phone:725-206-7929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1347983225100000X, 225100000X
NV4903225100000X
VA2305212513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859065Medicare PIN
IL208325005Medicare UPIN