Provider Demographics
NPI:1871732776
Name:SURMA, JENNIFER ANN (DPT)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ANN
Last Name:SURMA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 N. MOPAC EXPWY. STE 575
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2410
Mailing Address - Country:US
Mailing Address - Phone:512-821-1101
Mailing Address - Fax:512-821-1071
Practice Address - Street 1:100 E KLEBERG AVE STE 336
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-4581
Practice Address - Country:US
Practice Address - Phone:512-821-1101
Practice Address - Fax:512-821-1071
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist