Healthcare Provider Details

I. General information

NPI: 1336381003
Provider Name (Legal Business Name): J & A DRENNON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15066 LOS GATOS ALMADEN RD 120
LOS GATOS CA
95032-3909
US

IV. Provider business mailing address

2500 CHURCH AVE
SAN MARTIN CA
95046-9106
US

V. Phone/Fax

Practice location:
  • Phone: 408-390-1150
  • Fax: 408-351-4344
Mailing address:
  • Phone: 408-390-1150
  • Fax: 408-351-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28649
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251H1300X
TaxonomyHuman Factors Physical Therapist
License Number28649
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number28649
License Number StateCA

VIII. Authorized Official

Name: JEFFFREY DRENNON
Title or Position: CO-OWNER
Credential:
Phone: 408-390-1150