Healthcare Provider Details

I. General information

NPI: 1093044711
Provider Name (Legal Business Name): JENNIFER ANN PENNINGTON MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN WHEELER MPT

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S EL CAMINO REAL SUITE 102
OCEANSIDE CA
92054-6306
US

IV. Provider business mailing address

2204 S EL CAMINO REAL SUITE 102
OCEANSIDE CA
92054-6306
US

V. Phone/Fax

Practice location:
  • Phone: 760-477-1350
  • Fax: 760-754-6785
Mailing address:
  • Phone: 760-477-1350
  • Fax: 760-754-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: