Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 18135 | CA |
NPI | 1134661929 |
---|---|
Provider Name | Maureen Jennings |
First Address | Long Beach, CA 90822-5201 |
Second Address | Long Beach, CA 90822-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2016 |
Last Update Date | 09/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18135 | PT LICENCE (01) | CA |