Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1249060 | TX |
N | 2251G0304X | Physical Therapist - Geriatrics | 297723 | CA |
NPI | 1215416938 |
---|---|
Provider Name | Jennifer Celine Wu Medina |
First Address | San Antonio, TX 78245-3298 |
Second Address | Pleasanton, TX 78064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 05/11/2020 |