Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2-0225-9 | TX |
Y | 225200000X | Physical Therapy Assistant | 2-0225-9 | TX |
NPI | 1043792443 |
---|---|
Provider Name | Marion Louise Jolivette |
First Address | San Antonio, TX 78265-3284 |
Second Address | San Antonio, TX 78212-5512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2018 |
Last Update Date | 31/08/2018 |