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Contact Information

JACKIE M JACQUES, PTA 16675171
29804 HIGHWAY 101
SUITE #5
QUILCENE, WA98376
 Phone: 360-765-0888
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapy Assistant

225200000X
Indicates primary specialty

NPI Profile & details for JACKIE M JACQUES · (Female)

NPI Number 1588319214
Status Active
Credentials PTA 16675171
Entity Individual
Enumeration date 02/22/2022
Last updated 02/22/2022 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
  • WA License # 16675171
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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