Provider Demographics
NPI:1205711561
Name:JACQUES, ROBERT (LMT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:JACQUES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7422
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-7422
Mailing Address - Country:US
Mailing Address - Phone:325-733-2158
Mailing Address - Fax:
Practice Address - Street 1:2449 S WILLIS ST STE 207
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6200
Practice Address - Country:US
Practice Address - Phone:325-733-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT139092225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist