Provider Demographics
NPI:1902454135
Name:JASSO, LYNNETTE (PT)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:JASSO
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPURS LN STE 340
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1680
Mailing Address - Country:US
Mailing Address - Phone:210-798-8585
Mailing Address - Fax:210-768-8580
Practice Address - Street 1:11219 POTRANCO RD STE A-110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5848
Practice Address - Country:US
Practice Address - Phone:210-679-6900
Practice Address - Fax:210-679-6904
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1321111225100000X
CA307488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist