Provider Demographics
NPI:1699301127
Name:SALINAS, JESSA TAYLOR
Entity type:Individual
Prefix:MRS
First Name:JESSA
Middle Name:TAYLOR
Last Name:SALINAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JESSA
Other - Middle Name:TAYLOR
Other - Last Name:RENNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 ROCKBROOK DR APT 223
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 ROCKBROOK DR APT 223
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3814
Practice Address - Country:US
Practice Address - Phone:661-805-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TX20000384352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer