Basic Information
| Provider Information | |||||||||
| NPI: | 1700139417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMPTON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | P.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7401 S. MAIN | ||||||||
| Address2: | FONDREN ORTHOPEDIC GROUP L.L.P. | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137992300 | ||||||||
| FaxNumber: | 7137943380 | ||||||||
| Practice Location | |||||||||
| Address1: | 18411 WEST LAKE HOUSTON PARKWAY | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813123820 | ||||||||
| FaxNumber: | 2813123870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2012 | ||||||||
| LastUpdateDate: | 10/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2089545 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.