Provider Demographics
NPI:1972671006
Name:MCJUNKIN, JEAN ALLYSON (PT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ALLYSON
Last Name:MCJUNKIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ALLYSON
Other - Last Name:TEETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2431 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1519
Mailing Address - Country:US
Mailing Address - Phone:806-771-8008
Mailing Address - Fax:806-771-8009
Practice Address - Street 1:6202 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3691
Practice Address - Country:US
Practice Address - Phone:806-687-8008
Practice Address - Fax:806-687-8009
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00452261OtherMEDICARE RAILROAD
TX8T6886OtherBLUE CROSS BLUE SHIELD
TX8T6886OtherBLUE CROSS BLUE SHIELD