Healthcare Provider Details

I. General information

NPI: 1215345665
Provider Name (Legal Business Name): JENNA HAPAI EATON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA HAPAI P.T.

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 COTTAGE WAY
CARMICHAEL CA
95608-5612
US

IV. Provider business mailing address

6613 DUNMORE AVE
CITRUS HEIGHTS CA
95621-6403
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-8877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number40346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: