Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 295914 | CA |
N | 2251S0007X | Physical Therapist - Sports | 295914 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 295914 | CA |
NPI | 1467921452 |
---|---|
Provider Name | Mrs. Jeanine Ann Mcdonell |
First Address | Ventura, CA 93003-7844 |
Second Address | Camarillo, CA 93010-1502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2018 |
Last Update Date | 27/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
295914 | STATE LICENSE (01) | CA |